[Globus pharyngeus : etiologies, diagnosis and management. A narrative review]. / Globus pharyngé : étiologies, diagnostic et prise en charge. Revue narrative de la littérature.

Globus pharyngeus is a very common symptom in the general population. It is defined as a sensation of lump or foreign body in the throat, generally not accompanied by pain and relieved by eating. This last notion makes the differential diagnosis with dysphagia, which requires a different management. Its possible etiologies are complex and multiple, both organic and psychological, and many of them are still debated. Therefore, there is no consensus on the management and the treatment of globus pharyngeus. The purpose of this narrative review of the literature is to synthesize the current evidence regarding the causes, diagnostic strategy, and therapeutic management of globus pharyngeus.

Le globus pharyngé est un symptôme très fréquent dans la population générale. Il est défini comme une sensation de boule ou de corps étranger dans la gorge généralement, non accompagnée de douleurs et soulagée par l'alimentation. Cette dernière notion fait le diagnostic différentiel avec la dysphagie qui relève d'une mise au point et de traitements différents. Ses étiologies possibles sont complexes et multiples, aussi bien organiques que psychologiques et nombre d'entre elles restent débattues. Par conséquent, il n'existe aucun consensus sur la mise au point du globus pharyngé ni sur son traitement. Cette revue narrative de la littérature a pour objectif de synthétiser les données actuelles concernant les causes, la mise au point et la prise en charge thérapeutique du globus pharyngé.

Medical and psychiatric differential diagnoses of pediatric globus sensation: A case study with review discussion.

Globus hystericus, also known as globus pharyngeus or globus sensation, is characterized by the physical sensation of a mass in one's throat. Globus sensation is more common in adults and reported more rarely in children. Adult patients with globus sensation score higher on neuroticism, introversion, anxiety, and depression. However, not all patients with globus sensation have psychiatric abnormalities. Thus, it is important to share an atypical presentation in children and highlight the necessity of ruling out other organic causes. The present case study elucidates the process of ruling out medical etiologies of globus sensation in a young girl with anxiety and food aversion. We provide a review discussion of the differential diagnoses, both medical and psychiatric, of globus sensation in the pediatric population reported in past literature. The case study and review of pediatric globus sensation shows that the symptom can be associated with a wide array of psychological and medical diagnoses. The medical differential diagnoses of globus sensation include the gastroenteric system, laryngeal system, cardiovascular system, and nervous system. We encourage critical analysis of other potential diagnoses, given each patient's unique history and physical presentation.

Validation of Dose Conversion of Banxia Houpotang Based on Systematic Evaluation / 中国实验方剂学杂志

There are many different opinions on dose conversion of famous classical formulas from Treatise on Febrile Diseases or Synopsis of the Golden Chamber, which has become a difficult point in research and development of famous classical formulas. At present, the clinical application dose of Banxia Houpotang is similar to the viewpoint that 1 Liang is equivalent to 3 g, in order to provide scientific basis for this conversion method, this paper systematically evaluated the effectiveness of Banxia Houpotang in intervening globus hystericus. Randomized controlled trials (RCTs) of Banxia Houpotang in intervening globus hystericus from CNKI, VIP, Wanfang Data, China Biology Medicine (CBM), Web of Science and PubMed databases were collected online, the retrieval time was from inception to April 1, 2019. Two reviewers independently screened the literature, extracted the data and assessed the risk of bias of the included studies. Then, Meta analysis was performed by RevMan 5.3 software. A total of 17 RCTs involving 1 575 patients were included. The effective rate [relative risk (RR)=1.24, 95%confidence interval (CI) (1.18, 1.30), P<0.000 01] and the curative rate [RR=1.76, 95%CI (1.45, 2.15), P<0.000 01] of Banxia Houpotang in intervening globus hystericus were all better than the control group. Current evidence shows that Banxia Houpotang under the conversion of 3 g in 1 Liang has a significant effect on intervention of globus hystericus. Due to the limitations of quantity and quality of the included studies, the above conclusions need to be verified by more high-quality studies, but the author suggests that such dose conversion should be considered in the research and development of famous classical formulas.

A Meta-Analysis of Randomized Controlled Trials on Ban-Xia Hou-Po Decoction for Globus Hystericus / 世界科学技术-中医药现代化

This study was aimed to evaluate the clinical effectiveness of Ban-Xia Hou-Po (BXHP) decoction in the treatment of globus hystericus. Related literatures were systemically searched in the China National Knowledge Infrastructure (CNKI, 1979-2013), Weipu Database for Chinese Technical Periodicals (1989-2013), and PubMed/Medline. The methodological quality of included trials was assessed based on the Jadad scale. The available data was analyzed with RevMan software (version 5.2.0) provided by the Cochrane collaboration. The results showed that a total of 6 randomized controlled trials (RCTs), which contained 649 globus hystericus cases, were included. The meta-analysis showed that compared with modern medicine, the total therapeutic effect of BXHP decoction was RR=1.15, 95%CI (1.08, 1.23); compared with modern medicine treatment alone, the total therapeutic effect of combination between BXHP decoction and modern medicine was RR=1.43, 95%CI (1.19, 1.73). It was concluded that the current clinical evidences showed that the effectiveness of BXHP decoction alone or combined with modern medicine in the treatment of globus hystericus was higher than the treatment only with modern medicine. And there was no obvious side effect. However, due to the low-quality studies and small amount of samples, the results still required to be confirmed with more high-quality, multi-center, and large sample RCTs.

On Thought of Globus Hystericus Treated by Basing on Differentiation of Signs / 浙江中医药大学学报

[Objective]To discuss the treatment based on syndrome differentiation of globus hystericus.[Methods]We combine consulting historical literatures with clinical experience and completely summarize the syndrome differentiation of globus hystericus.[Results]More pathogenesis can lead to globus hysteri-cus from clinical practice, such as insufficiency of heart yang ,insufficient kidney yang and exogenous pathogenic factors. In the principle of syndrome dif-ferentiation, we must base on the different pathogenesis to treat globus hystericus. [Conclusion]Because of its complexity, we can not rapidly draw a con-clusion without a careful analysis when facing globus hystericus and its like, which leads us to neglect the potential dangerous factors.

Wang Hui's Smart Experience in Applying Canker-root Wendan Decoction / 浙江中医药大学学报

Mr. Wang Hui respects but is not stubborn to ancient,paying attention to combination of differentiation of signs and diseases; in smartly applying Canker-root Wendan Decoction,he often adds Chendanxing to reinforce removing heat and sputum,emphasizing that signs of red tongue,yellow and greasy or white moss,bitter mouth,slippery and quick pulse show sputum heat bothering internal,can apply the formula,which embodying the treatment principle of "treat different diseases with same method".

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.

Stress Perception and Coping Strategy of Patients with Globus Hystericus / 신경정신의학

OBJECTIVES: This study was designed to compare the relationships of psychopathology, stress event frequency and stress perception between globus hystericus patients and normal subjects, and to assess coping strategy and susceptibility for assisting the understanding of psychological mechanism and future treatment modalities. METHODS: Thirty-two globus hystericus patients who were consulted from the department of otolaryngology and fifty-three healthy subjects participated in this study. The authors used SCL-90-R(Korean Symptom Check List-90-Revision) for the measurement of psychiatric symptoms, GARS(Global Assessment of Recent Stress Scale) for stress perception, Social Readjustment Rating Scale for stress frequency and the Weisman Coping Strategy Scale for coping ability and susceptibility. The SPSS version 10.0 for Windows was used for statistical analysis. RESULTS: 1) Comparison of demographic characteristics showed no significant difference except level of education, which was significantly lower in the patient group. 2) The score of depression and anxiety items in SCL-90-R were significantly higher in the patient group. 3) The score of all subclasses in the GARS scale was significantly higher in the patient group. 4) The scores of neutral life event frequency, negative life event frequency, and negative life events more than 1 year past in social Readijustment Rating Scale, were significantly higher in the patient group, but there was no significant difference in positive life event frequency. 5) Weisman Coping Strategy Scale showed suppression, compliance, redefinition, intellectualism and displacement to be higher in frequency in descending order. Projection and fatalism were lower in frequency. 6)The patient group was susceptible to frustration, anxiety & fear, depression in descending order. CONCLUSION: Globus hystericus patients showed higher stress frequency, stress perception, and used positive coping strategies. Globus hystericus has an intimate association with stress factors, so an appropriate management is required in view of treatment.