Center for Psychosocial Research in GI, and Esophageal Disorders Research Center, Northwestern University, Feinberg School of Medicine, Division of Gastroenterology, Chicago, IL, USA.
Dis Esophagus. 2010 Sep;23(7):545-53. doi: 10.1111/j.1442-2050.2010.01064.x. Epub 2010 May 4.
Globus sensation is a bothersome and difficult symptom to treat. The aims of this study were to evaluate the acceptability and utility of hypnotically-assisted relaxation (HAR) in decreasing the perception of globus sensation and the effect of HAR on interdeglutitive upper esophageal sphincter (UES) pressure. Sixteen subjects with persistent globus sensation unresponsive to therapy for reflux disease and with normal esophageal/laryngeal imaging studies were invited to participate in a 7-session clinical protocol. Before and after HAR, subjects completed standard questionnaires including the esophageal symptoms questionnaire. High-resolution manometric assessment of respiratory augmentation and average resting UES pressure were assessed before and after HAR. Ten of the 16 subjects agreed to participate in the protocol. All participants were women with median age 51.5 (range 30-72 years). The participants found HAR acceptable and completed the entire 7-session trial. Globus symptom severity varied widely pre-treatment (median=52.5, range 16-72), and 9 of 10 subjects reported a reduction in globus symptomatology following treatment (median=14.0, range 3-19; P=.007). Only 1 subject exhibited abnormal respiratory augmentation of UES pressure (>27 mm Hg) prior to treatment and was normal following treatment (9.9 mm Hg). Resting UES pressure was normal in all subjects (<118 mm Hg). Group respiratory augmentation and average resting UES pressure were unaffected by HAR (P=.48, .89). This case series suggests that HAR can provide a substantial improvement in globus sensation irrespective of cause. UES function was unaffected. We suggest that HAR therapy is an acceptable and useful intervention for patients with globus sensation.
球感是一种令人烦恼且难以治疗的症状。本研究旨在评估催眠辅助放松（HAR）在降低球感感知方面的可接受性和实用性，以及 HAR 对吞咽间食管上括约肌（UES）压力的影响。我们邀请了 16 名患有持续性球感的患者参与本研究，这些患者对反流疾病的治疗反应不佳，且食管/喉影像学检查正常。在 7 次临床方案治疗前后，受试者完成了标准问卷，包括食管症状问卷。在 HAR 前后，我们对呼吸增强的高分辨率测压和平均静息 UES 压力进行了评估。16 名患者中有 10 名同意参与该方案。所有参与者均为女性，中位年龄为 51.5 岁（范围 30-72 岁）。参与者认为 HAR 是可以接受的，并完成了整个 7 次治疗。治疗前球感症状严重程度差异很大（中位数=52.5，范围 16-72），10 名患者中有 9 名报告治疗后球感症状减轻（中位数=14.0，范围 3-19；P=.007）。仅 1 名患者在治疗前存在 UES 压力的异常呼吸增强（>27mmHg），治疗后恢复正常（9.9mmHg）。所有受试者的静息 UES 压力均正常（<118mmHg）。HAR 对组呼吸增强和平均静息 UES 压力无影响（P=.48，.89）。本病例系列研究表明，HAR 可显著改善球感，无论病因如何。UES 功能不受影响。我们建议 HAR 治疗是一种可接受且有用的干预措施，适用于球感患者。
