咽部异物感:现状与困境。
Globus: Current Concepts and Dilemmas.
机构信息
Esophageal and Functional GI Disorders Division, Gedyt, Diagnostic & Therapeutic Gastroenterology and Endoscopy, Buenos Aires, Argentina.
Digestive Health Center, Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center at MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
出版信息
J Clin Gastroenterol. 2018 Nov/Dec;52(10):845-852. doi: 10.1097/MCG.0000000000001129.
Globus is an area of interest for many medical specialists including otorhinolaryngologists, gastroenterologist, allergists, and psychiatrists. It may be caused by an organic disease, but it is not uncommon that an underlying etiology remains unidentified even after a full workup has been performed. Patients who suffer from globus usually visit several physicians from different specialties without finding a solution for their symptoms. Identifying the underlying cause of globus is not always a simple task; therefore, structural or functional abnormalities of the thyroid, larynx, pharynx, and esophagus should be investigated. Gastroesophageal reflux disease is commonly considered to be the underlying cause after being identified in an otorhinolarygeal (ear, nose, and throat) evaluation, which is usually the first diagnostic step. In the last few years, an inlet patch in the proximal esophagus has been shown to be associated with globus, and its elimination has resulted in symptom resolution in some patients. Finally, globus can be associated with psychiatric disorders as well as oropharyngeal hypersensitivity that could be either chemical or mechanical. Treatment is directed toward an identified organic cause; in those with a functional disorder, the mainstay of therapy includes neuromodulators and psychiatric/psychological interventions.
球状物是许多医学专家关注的领域,包括耳鼻喉科医生、胃肠病学家、过敏学家和精神科医生。它可能是由器质性疾病引起的,但即使经过全面检查,也常常无法确定潜在的病因。患有球状物的患者通常会从不同的专科看几个医生,但他们的症状仍未得到解决。确定球状物的根本原因并不总是一项简单的任务;因此,应调查甲状腺、喉咙、咽部和食管的结构或功能异常。在耳鼻喉科(耳朵、鼻子和喉咙)评估中发现胃食管反流病后,通常会将其视为潜在的病因,这通常是第一步诊断。在过去几年中,近端食管中的入口斑块已被证明与球状物有关,并且在一些患者中,消除该斑块可导致症状缓解。最后,球状物也可能与精神障碍以及口咽部高敏有关,这种高敏可能是化学性的或机械性的。治疗针对的是明确的器质性病因;对于功能性疾病,治疗的主要方法包括神经调节剂和精神科/心理干预。