What to Do for Globus and IBS
Medically reviewed by Jay N. Yepuri, MD
Globus, also referred to as globus pharyngeus, is a symptom that can occur with irritable bowel syndrome (IBS) that causes you to feel as if something is stuck in your throat. It is a less common symptom of IBS but one that is often accompanied by burping, throat pain, and heartburn.
Globus is very common with gastroesophageal reflux (GERD), a condition that frequently co-occurs with IBS. As such, globus may occur independently with IBS, be caused by an accompanying condition like GERD, or involve both. Psychological factors like anxiety and depression can also play a part.
This article explains what causes globus, including its link to IBS. It also describes how globus is diagnosed and treated when it co-occurs with IBS.
What Is Globus?
Globus is a painless sensation that something is stuck in your throat when nothing is there. Some people describe it as having "a lump in the throat" or a tightening or constricting sensation. The symptom may be persistent or intermittent and may occur on its own or with other gastrointestinal (GI) symptoms.
Globus is surprisingly common, accounting for up to 5% of referrals to ear, nose, and throat (ENT) specialists. Studies suggest that up to 45% of people will experience globus at some point in their lives.
While GERD is commonly linked to globus, it is linked to other many conditions, including psychological ones.
Symptoms of Globus
Globus is generally painless but can be aggravating and disruptive to your life. It can manifest differently in different people but often causes symptoms like:
The sensation of a lump moving up and down as you swallow, eat, or drink
A choking sensation
A persistent clearing of the throat
Chronic cough
Vocal hoarseness
Rubbery mucus at the back of the throat (cattarh)
The symptoms are mainly situated in the central part of the suprasternal region. This is the soft, concave part of the neck just below your larynx (voice box) and just above the sternum (breastbone).
Depending on the cause, globus may be accompanied by:
Burping and belching
Heartburn
Difficulty swallowing (dysphagia)
Pain with swallowing
A bloody cough or saliva (hemoptysis)
Weight loss
Causes of Globus
The cause of globus is poorly understood and may be due to an individual factor or several overlapping factors broadly categorized as being inflammatory, functional, or psychological.
Upper GI Inflammation
Globus may be caused by inflammation of the larynx or pharynx (throat). Inflammation is the body's response to an injury or infection, causing affected tissues to become warm, swollen, and tender. The hypersensitivity of the laryngeal or pharyngeal tissues can lead to globus.
Many upper GI tract conditions can cause this, including:
GERD (due largely to the reflux of acid in the esophagus)
Hiatal hernia (which can also trigger acid reflux due to abnormal bend of the esophagus)
Sinusitis (a sinus infection that can cause postnasal drip and inflammation)
Cricopharyngeal spasm (a spasm of a muscle in the pharynx)
Lingual tonsillitis (infection of the tonsils situated near the base of the tongue)
Cervical osteophytosis (bone spurs of the cervical spine of the neck)
Goiter (an abnormally large thyroid gland caused by thyroid disease)
Functional Motility Disorders
Peristalsis is the muscular contractions that move food through the GI tract. Functional motility disorders are those in which peristalsis is abnormal or doesn't work at all.
Functional motility disorders associated with globus involve the upper esophageal sphincter (UES), also known as the cricopharyngeal sphincter. This is the ring-shaped muscle that closes the esophagus (feeding tube) to prevent the reflux of food into the airways or the entry of air into the digestive tract.
The inappropriate contraction of the cricopharyngeal sphincter can very much cause the sensation of something being stuck in the throat.
Psychological Causes
Psychological factors may also play a role in globus. Some studies suggest that up to 96% of people with globus report a worsening of symptoms with increased anxiety or depression.
While anxiety and depression can aggravate globus caused by conditions like GERD, they can also trigger globus in the absence of a physical cause. Anxiety and depression are well known to cause somatic (physical) symptoms. In fact, globus is typically included on questionnaires investigating panic disorder and generalized anxiety disorder.
Some studies have shown a strong link between a stressful lifestyle and globus. Sleep disorders are also closely linked.
Link Between Globus and IBS
Irritable bowel syndrome can be linked to IBS in several different ways:
IBS is a type of functional motility disorder. While IBS is generally associated with lower GI symptoms, such as diarrhea or constipation, some people experience more upper GI symptoms. As a distinct functional disorder, IBS can affect any part of the GI tract.
IBS and GERD are closely linked. Studies vary, but some suggest that nearly half of all people with IBS have GERD.
IBS is associated with high rates of anxiety and depression. A 2023 review suggests that the rate of anxiety and depression among people with IBS is 39% and 29%, respectively.
Either alone or in combination, these factors can contribute to the onset of globus symptoms in people with IBS.
How Globus Is Diagnosed
Globus is a diagnosis of exclusion, meaning it is made after other health problems have been ruled out.
If you are experiencing globus symptoms, you should be seen by an ear, nose, and throat (ENT) healthcare provider. They may recommend one or more of the following diagnostic tests:
Barium swallow (X-rays taken after swallowing a barium solution)
Endoscopy (a tube inserted through your mouth into your esophagus)
Esophageal manometry (insertion of a tube containing sensors designed for measuring muscle contractions in your esophagus)
Nasolaryngoscopy (a narrow tube inserted through your nose into your throat)
Videofluoroscopy (X-rays taken while eating and drinking)
Could It Be Cancer?
It is only natural to worry that the sensation of a foreign body in your throat could be a sign of a cancerous tumor. Rest assured this is rarely the case. Still, it is essential to tell your healthcare provider about your symptoms for a proper diagnostic workup.
Symptoms not typically associated with globus that might be indicative of cancer include:
Pain during swallowing
Difficulty swallowing
Unexplained weight loss
Sensation on one side of the throat only
Solid foods get stuck in the throat
Worsening/constant symptoms
Visual or palpable mass in or around the throat area
Signs of bleeding in the mouth
Treating Globus and IBS
Most of the time, all that is needed for dealing with globus is the reassurance that you don't have cancer.
However, if your symptoms are quite disruptive and distracting, other treatments are available. In some cases, treatment may be recommended because it addresses any possible underlying contributors to the symptom, while in other cases, the treatment recommended focuses directly on globus.
Here are some possible options:
Therapy with a speech and language pathologist
Medication and diet changes to reduce acid reflux
Cognitive behavioral therapy (CBT)
Antidepressants
Surgery is a very rarely used modality but may be recommended if a thyroid disease or an anatomical epiglottis problem (retroverted epiglottis) is present.
Overlap With IBS
If you have IBS, there are some things you can do to help ease the symptoms of both globus and more "classic" symptoms of IBS, such as constipation and diarrhea:
Drink lots of water, which helps to keep the throat area from becoming too dry while also replacing liquids lost by diarrhea episodes (IBS with diarrhea) or keeping the stool moist (for IBS with constipation).
Avoid alcohol, coffee, and carbonated drinks that can be irritants to your entire digestive system.
Offset the stress in your life either through CBT, the use of relaxation exercises, or through other mind/body activities such as yoga, tai chi, or meditation.
Summary
Globus is the sensation that something is stuck in your throat. It can occur with IBS for different reasons.
Firstly, globus is closely linked to functional motility disorders, and IBS is a functional motility disorder. Secondly, GERD is one of the more common causes of globus, and nearly half of all people with IBS have GERD. Thirdly, anxiety and depression are common triggers for globus, and people with IBS are commonly affected by anxiety and depression.
The diagnosis of globus is based on the exclusion of all other possible causes. There is no standard treatment for globus, but medications and psychotherapy may be involved.
Read the original article on Verywell Health.
