Clinical and psychological characteristics of patients with globus

Efficacy analysis of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model in the management of globus syndrome

OBJECTIVE

The aim of this study is to investigate the clinical efficacy of the empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome.

METHOD

Sixty-nine newly diagnosed patients with globus syndrome at the Wenzhou People's Hospital Department of Gastroenterology outpatient clinic were enrolled in this study. After obtaining informed consent, patients were randomly assigned to either the observation group (attribution analysis-cognitive restructuring-classical pharmacotherapy; n = 35) or the control group (pharmacotherapy alone; n = 34), with a treatment course of 4 weeks. Efficacy assessments were conducted before and during treatment using the 9-item Patient Health Questionnaire-9 (PHQ-9), the 7-item Generalized Anxiety Disorder-7 (GAD-7), and the Patient Health Questionnaire-15 (PHQ-15).

RESULTS

After four weeks of treatment, the total efficacy rate was 100 % in the observation group and 27.6 % in the control group, with a statistically significant difference between the groups (P < 0.05). Scores on the PHQ-9, GAD-7, and PHQ-15 significantly improved in the observation group compared to before treatment and were better than those in the control group, with statistically significant differences (P < 0.05).

CONCLUSION

The empathy-based attribution analysis-cognitive restructuring-pharmacological treatment model for the management of globus syndrome demonstrated good clinical efficacy, providing strong evidence for further clinical promotion.

[Reliability and validity of the German version of the Glasgow Edinburgh Throat Scale]

BACKGROUND

Many patients who consult the ENT doctor suffer from globus sensation, as a term for a multifactorial symptom description. It is particularly important during initial consultation to take the often-sensitive patients seriously and to offer a structured diagnostic clarification. Today, there is a lack of a screening tool in everyday clinical practice that can be used to differentiate the globus sensations more closely and assess their severity OBJECTIVES: The reliability and validity of the German version of the Glasgow Edinburgh Throat Scale (GETS) were examined.

MATERIALS UND METHODS

The original GETS questionnaire was translated into German (GETS-G) and completed by 60 patients with globus sensation (>3 months) in a prospective observational study. All patients received a clinical examination a sonography of the neck. In patients without an identifiable organic cause, a pH monitoring was carried out.

RESULTS

A local organic cause for the globus sensation was found in 30 patients (50%). In addition, reflux was detected in 24 patients (40%) using pH monitoring. No cause could be determined in only 6 patients (10%). According to the overall score (Q1-Q12), there was no significant difference between these three groups. The Cronbach's alpha for assessing reliability was 0.88 in the 12-item analysis. Principal component analysis yielded a globus scale, dysphagia scale and a chronic pharyngeal irritation scale.

CONCLUSIONS

The GETS-G showed high reliability and validity, which justifies its use in patients with globus sensation in German-speaking countries and may lead to a better assessment of the severity of this symptom.

Differences in Diagnostic Rates After Hypopharyngeal-esophageal Impedance-pH Monitoring of Laryngopharyngeal Reflux Patients by Age and Sex

PURPOSE

To evaluate the differences in diagnostic rates according to the age and sex of patients with suspected laryngopharyngeal reflux (LPR) symptoms and completed the 24-hour hypopharyngeal-esophageal multichannel intraluminal impedance-pH (24h-HEMII-pH) monitoring.

METHODS

Patients with LPR symptoms underwent the 24h-HEMII-pH monitoring. We compared the diagnostic rates of LPR in patients with LPR symptoms according to age and sex. The number of reflux episodes and type of reflux were compared among patients who were confirmed to have LPR according to age and sex.

RESULTS

A total of 249 patients with suspected LPR symptoms who completed 24h-HEMII-pH monitoring were analyzed. A total of 170 patients (68.3%) were diagnosed with LPR after 24h-HEMII-pH monitoring. There were 57 (67.1%) men and 113 (68.9%) women. The old age group (older than 55 years) showed a statistically significant higher diagnostic rate than the young age group (73.5%, 60.8%, p=0.034). Women's diagnostic rate was statistically higher in the old age group than that in the young age group (75% vs. 58.3%, p=0.026). There were no specific differences in the number of refluxes in the diagnosed patients between the age groups, and there were no differences in the initial reflux symptom index.

CONCLUSIONS

Among those who visited the clinic with suspected LPR symptoms and performed 24h-HEMII-pH monitoring, the diagnostic rate of LPR was higher in the older age group than that in the younger age group.

The Relationship Between Upper Esophageal Sphincter Pressure and Psychological Status in Patients with Globus Sensation

Objective

To explore the correlation between changes in esophageal pressure and psychological status in patients with globus sensation.

Methods

A total of 40 patients with globus sensation who attended Wenzhou People’s Hospital between August 2020 and February 2021 were divided into two groups based on the results of esophageal manometry: a high-pressure group and a non-high-pressure group. The duration of disease, clinical symptom score, and self-rating anxiety scale (SAS) were compared between the two groups to determine the relationship between changes in esophageal pressure and psychological status.

Results

All the patients before treatment were divided into a high-pressure group (n = 14) and a non-high-pressure group (n = 26) according to whether the resting pressure of the upper esophageal sphincter (UES) was greater than 104 mmHg. The differences between the high-pressure group and non-high-pressure group in duration of disease, clinical symptom score, and SAS were statistically significant (all P < 0.05). Anxiety was present in 12 patients in the high-pressure group and two patients in the non-high-pressure group. The difference between the the high-pressure group and non-high-pressure group in the incidence of anxiety was statistically significant (χ² = 21.04 and P < 0.001). Pearson correlation analysis of the association between esophageal pressure and anxiety resulted in R = 0.74 and P < 0.001.

Conclusion

Patients with globus sensation who develop anxiety were more likely to have high pressure in the upper esophageal sphincter.

Personality of patients with fecal incontinence

BACKGROUND/AIMS

Although idiopathic fecal incontinence (FI) patients have some psychological characteristics, the personality of FI patients was not described. The present study aims to describe the clinical and personality characteristics of FI patients.

PATIENTS AND METHODS

This retrospective observational study included 996 outpatients, 72 with fecal incontinence. They filled out the Rome III diagnostic questionnaire, the personality inventory MMPI-2, the questionnaires for urological and sexual disorders, and Likert scales for bowel disorders perceived symptom severity. The main outcome measures were the presence in FI patients of functional gastrointestinal disorders, the self-reported symptom severity, and the personality profile.

RESULTS

Patients were mainly females (72%). FI patients were characterized by higher age (P = 0.015), and by a higher prevalence of functional diarrhea (P = 0.001), urological (P = 0.001), and sexual disorders (P = 0.005). These patients also report higher diarrhea severity (P < 0.001) and lower abdominal pain severity (P = 0.009). The personality of FI patients is distinguished by a higher score for psychopathic deviate (P = 0.006), social responsibility (P = 0.003), Mac Andrew revised scale (P = 0.005), and antisocial practice (P = 0.007), and a lower score for type A behavior (P = 0.005).

CONCLUSION

FI patients are characterized not only by older age, and a high prevalence of diarrhea but also by a specific personality profile characterized by an unfavorable comparison with others.

Psychological profiles of irritable bowel syndrome patients with different phenotypes

BACKGROUND/AIMS

Abnormal psychological profiles are frequently found in patients with functional gastrointestinal disorders (FGIDs). The present study aimed to evaluate the psychological profiles of FGID patients with irritable bowel syndrome (IBS), and IBS phenotypes.

METHODS

In 608 FGID patients, including 235 with IBS, have filled a Rome III questionnaire and the French version of the Minnesota Multiphasic Personality Inventory 2. Data analysis was performed using univariate analysis and multivariate logistic regression.

RESULTS

This study shows that IBS patients have abnormal psychological profiles with more significant symptom exaggeration and decreased test defensiveness than non-IBS patients. They have a significantly higher score for all clinical scales. Logistic regression analysis showed in IBS patients a decrease of body mass index (P= 0.002), and test defensiveness score K (P= 0.001) and an increase of Hypochondriasis (P< 0.001) and Masculinity-Femininity scale (P= 0.018). By comparison with non-IBS patients, IBS-constipation, IBS-diarrhea, and mixed IBS patients have increased Hypochondriasis value and Depression score, mixed IBS patients have higher Psychasthenia score and higher Hypomania score. No item was significantly different in the IBS-unspecified group.

CONCLUSIONS

This study shows that IBS patients have different psychological profiles than other FGID patients and that psychological characteristics are associated with IBS phenotypes except for patients with unsubtyped IBS.

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Globus is a non-painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause-and-effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high-resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid-suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long-term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.