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Hyperdynamic Upper Esophageal Sphincter Pressure: A Manometric Observation in Patients Reporting Globus Sensation

Kwiatek, Monika A., PhD1; Mirza, Faiz, MD1; Kahrilas, Peter J., MD1; Pandolfino, John E., MD1

American Journal of Gastroenterology: February 2009 - Volume 104 - Issue 2 - p 289–298

OBJECTIVES: Although globus sensation is a common symptom, its pathogenesis is poorly defined. The aim of this study was to quantify the timing and magnitude of respiratory variation in upper esophageal sphincter (UES) pressure with high-resolution manometry (HRM) in patients with globus sensation, normal controls, and gastroesophageal reflux disease (GERD) patients without globus sensation.

METHODS: HRM recordings spanning from the hypopharynx to the stomach were analyzed in 131 consecutive globus patients with normal (64) and abnormal (67) distal esophageal motility. Resting UES pressure was analyzed up to 5 min before 10 5-ml water swallows. Change in UES pressure, its average magnitude between inspiration and expiration, and nadir UES relaxation pressure in globus patients were compared with those in 68 controls and 46 GERD patients without globus.

RESULTS: UES pressure typically increased during inspiration in both controls and patients. Respiration-related change in resting UES pressure was significantly amplified in globus patients (37.3 mm Hg) compared with controls (10.6 mm Hg) and GERD patients (13.0 mm Hg) (P<0.0001). A respiratory change in UES pressure >27 mm Hg was found in > 60% of globus patients and <15% of controls and GERD patients without globus. This hyperdynamic UES was not associated with other abnormalities of esophageal motor function.

CONCLUSIONS: Hyperdynamic respiratory UES pressure changes were prevalent in patients reporting globus sensation irrespective of their deglutitive UES and distal esophageal motility. Although the etiology of this hyperdynamic UES is unclear, it does appear to be a frequent manometric observation in this patient group and may provide a new focus for further studies into pathogenesis and therapy.

Am J Gastroenterol 2009; 104:289-298; doi:10.1038/ajg.2008.150; published online 20 January 2009

1Division of Gastroenterology, Department of Medicine, The Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.

Correspondence: Monika A. Kwiatek, PhD, Division of Gastroenterology, Department of Medicine, Feinberg School of Medicine, Northwestern University, 676 N. St Clair Street, Suite 1400, Chicago, Illinois 60611, USA. E-mail:

Received 7 April 2008; accepted 12 August 2008

© The American College of Gastroenterology 2009. All Rights Reserved.
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