Management of globus
This topic describes the management of globus. For general advice about managing functional gastrointestinal disorders, including patient support and psychiatric or psychological assessment, see Approach to managing functional gastrointestinal disorders.
There are no reliably effective treatments for globus. Reassure patients that the condition is benign and the sensation of a lump in the throat is normal in particular circumstances (eg at a time of emotion, as in the common term ‘it brought a lump to his throat’).
If anxiety is suspected to be the cause, or in patients who experience anxiety as a result of the symptoms of globus, treat the anxiety (see Managing anxiety and associated disorders in adults and young people).
Proton pump inhibitors (PPI) can be trialled as gastro-oesophageal reflux (GORD) may be contributing to symptoms (see Management of extra-oesophageal symptoms of GORD in adults for dosages). If the symptoms do not respond to a PPI trial, therapy should be stopped. If the symptoms respond to PPI therapy, the lowest effective dose should be determined—this may require several trials on and off treatment to determine efficacy.
Fundoplication is not an effective treatment for globus, particularly in the absence of typical reflux symptoms and without abnormal oesophageal acidification on pH monitoring.