A lump in the throat may be caused by globus sensation

Q: I am a 58-year-old man. Every now and then, I have a feeling there is a lump in my throat. It feels like my uvula (the piece of flesh protruding from the roof of the mouth) is touching the inner part of my tongue. Sometimes, I have difficulty swallowing food, such as crushed peanuts and pills. There are times in the day when I do not feel the symptoms at all.

I saw an ear, nose and throat (ENT) specialist, a gastroenterologist and a traditional Chinese medicine practitioner. They said my symptoms are those of gastro-oesophageal reflux disease (GERD). Omeprazole, esomeprazole, magnesium and TCM medicine were prescribed. All seemed to work for a while before the symptoms returned.

I am back to feeling the lump every day and it is fairly uncomfortable. I am worried that there may be something more sinister regarding my condition. Is there a cure or do I have to live with the symptoms? What type of specialist should I see?

Rep​lies by Dr Vikneswaran Namasivayam​, Senior C​on​sultant, Department of Gastroenterology and Hepatology, Singapore General Hospital (SGH), a member of the SingHealth​ group.

A: The sensation of having a lump in the throat is​ called globus sensation. It is not painful and may be present even when the individual is not eating. It is different from dysphagia, which refers either to difficulty with the act of swallowing or a sensation of obstructed passage when one is trying to swallow food or liquid.

Globus sensation is very common and may occur in otherwise healthy individuals. The cause of globus sensation is unknown. GERD refers to the abnormal movement of acid from the stomach up into the oesophagus (food pipe) that gives rise to symptoms. It has been implicated as one of the causes of globus sensation, though this is probably true only in a minority of patients.​

Some patients with globus sensation may have increased sensitivity of the nerves of the gut. This leads to the perception of a lump in the absence of any growth. Stress has also been implicated in contributing to globus sensation. A minority of patients may have abnormal acid-producing tissue within the food pipe that may be causing the globus sensation as a result of irritation from the acid produced by the abnormal tissue.

Unlike dysphagia, which can be a symptom of a serious condition such as a stroke or throat cancer, globus sensation is a benign condition and most patients do not have any underlying serious conditions. Patients may experience the sensation for several years. Some patients may become particularly bothered by the sensation and it is often the fear of a serious underlying problem that leads to medical attention. The distinction between globus sensation and dysphagia may be difficult to make at times and further tests may be carried out in these instances.

Initial evaluation typically involves looking for a growth within the oral cavity and food pipe by the ENT surgeon and gastroenterologist respectively. This may entail either evaluation by scans or endoscopy (examination of the food pipe by inserting a long flexible tube with a camera). In some instances, weakness or the incoordination of the muscles involved in the act of swallowing may give rise to symptoms.

These typically occur in patients with underlying neurological diseases, such as a previous stroke or Parkinson’s disease. So in patients with continued troubling symptoms, additional tests may include assessment of swallowing with real-time video recordings of swallowing (videofluoroscopic study) and assessment of the oesophageal function (oesophageal manometry).

Such tests, however, are required only in a minority of patients when there is diagnostic uncertainty. Most patients with globus sensation do not require extensive testing. An explanation and reassurance that the nature of globus sensation is benign are all that is needed for the majority of patients. Medication may be given to some patients. This includes acid blocking medication to treat underlying GERD, such as proton pump inhibitors, and medication to reduce the sensitivity of the nerves in the gut, such as tricyclic antidepressants.

Endoscopic treatment has been tried with some measure of success in ablating abnormal acid-producing tissue in the food pipe, but this is not recommended as a routine for the vast majority of patients as it carries some risks.

Ref: S13