Clinical Predictors for Response to Proton Pump Inhibitor Treatment in Patients With Globus

BACKGROUND/AIMS: Globus is a persistent or intermittent non-painful sensation of a lump or foreign body in the throat. Given the benign nature of the condition and the association of gastroesophageal reflux disease, empirical therapy with proton pump inhibitor seems reasonable for patients with typical globus. The aim of this study was to investigate the clinical predictors for symptom response to short-term proton pump inhibitor treatment in patients with globus symptom. METHODS: Fifty-four patients with globus symptom were enrolled prospectively. All patients were treated with pantoprazole 40 mg daily for 4 weeks. Treatment response was defined as a > 50% reduction in symptom scores between symptom assessments. Univariate and multivariate logistic regression analysis between responders and non-responders was performed to identify variables predicting response to pantoprazole treatment. RESULTS: Of the 54 consecutive patients considered, 13 were excluded on the basis of exclusion criteria and/or refusal to participate in the study. Finally, 41 patients were included in this study. After 4-week pantoprazole treatment, 22 patients (53.7%) were classified as responders. On multivariate analysis, the presence of reflux symptom was associated with a higher response rate to 4-week pantoprazole treatment (OR, 68.56; P = 0.043), and long symptom duration (> or = 3 months) were associated with a lower response rate to pantoprazole treatment (OR, 0.03; P = 0.034). CONCLUSIONS: Presence of reflux symptom and short symptom duration were independent predictors of responsiveness to 4-week pantoprazole treatment in patients with globus.

Clinical Characteristics of Emergency Patients with Asthenia Universalis: Elderly Versus Adult Patients

PURPOSE: Asthenia universalis is a common symptoms complaint found in the emergency department (ED) especially among the elderly. However, emergency physicians often find it difficult to initiate evaluation given lack of research in this field. The aim of this study is to evaluate the clinical characteristics of asthenia universalis in elderly patients and compare them to adult patients presenting to the ED for similar complaints. METHODS: Patients who presented to the ED with asthenia universalis between March 2004 through February 2005 were obtained using data warehouse from electronic medical records. We excluded patients with underlying illness such as neurosis, organic diseases, depression, in addition to patients who refused to participate. Characteristics of the elderly group (> 64 years) were compared with the adult group (15~64 years) based on clinical and laboratory findings. Chi-square test a Fisher's test was used for nominal variables and a Mann-Whitney U test or Students t-test for continuous variables was used. RESULTS: During the study period asthenic patients comprised 0.81% (566/ 69,922) of total ED visits. Of those 566 patients, 82 patients were included in the study of which 25 were male and 56 female. Both genders were equally distributed between the two groups studied (elderly vs. adult). 58.3% of patients had an underlying medical illness (elderly group 81.1%, adult group 46.2%). The clinical impressions included infections or inflammation disorders (30.5%), endocrine disorders (17.1%), and psychiatric illnesses excluding depression (15.9%). Laboratory findings revealed a higher prevalence of hyponatremia (p=0.008), hypokalmia (p=0.033) and hypoalbuminemia (p=0.036) in the elderly group. CONCLUSION: In elderly patients presenting with asthenia universalis to the ED, a higher prevalence of underlying infections and endocrine disorders were present compared to adult patients presenting with asthenia universalis. In addition, the elderly more frequently had associated laboratory abnormalities to include hyponatremia, hypokalemia, hypoalbuminenia when compared to the adult patients.