Di Stefano M, Bergonzi M, Mengoli C, et al. Digestive and Liver Disease. 2013 Mar;45:S117.
OBJECTIVES: The aim of this study was to investigate distal and oropharingeal acid exposure in patients with non-erosive reflux disease (NERD) with and without globus.
RESULTS: Patients reporting globus showed no difference in distal esophagus acid exposure (pH <4), acidic and weakly acidic reflux episodes, or proximal extension of refluxate compared with controls. On the contrary, they showed significantly longer oropharyngeal exposure to pH<5.5 compared to controls, both considering the whole time (222 min ± 230 min vs 47 min ± 88 min, p<0.05) and the percentage of exposure (16.07±16.2% vs 3.56±6.84%, p<0.05); moreover, the duration of the longest episode of oropharyngeal acid exposure was significantly longer in patients with globus (110 min ± 115 min) than in patients with typical symptoms (15 min ± 25 min; p<0.05). One patient with globus showed a hypotensive UES and one a hypertensive UES; no specific esophageal motor disorder proved to be more frequent in the globus group compared to controls. A higher score for pyrosis was evident in the control group (3.45±3.31 vs 1.31±1.44); no difference was found in regurgitate, cough, sore throat, or thoracic pain score.
CONCLUSION: Oropharyngeal acid exposure could be an important pathogenetic mechanism in globus. Oropharyngeal pH monitoring seems a more accurate diagnostic tool than the standard 24-hr pH-impedance study to define the role of acid exposure in this subgroup of patients.