Kim Ji Eun, Lee Hyun Joo, Kim Min-Ji, Min Yang Won, Rhee Poong-Lyul
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
J Neurogastroenterol Motil. 2025 Apr 30;31(2):210-217. doi: 10.5056/jnm24096. Epub 2024 Dec 3.
BACKGROUND/AIMS: Globus is often linked with gastroesophageal reflux disease, which influences its treatment strategies. This study aims to investigate clinical characteristics of patients with refractory proton pump inhibitor (PPI) globus to better understand its etiology.
Between 2017 and 2023, 122 out of 592 patients with globus from the Samsung Medical Center outpatient clinic who were unresponsive to 8 weeks of PPI treatment were analyzed. Patients underwent 24-hour esophageal pH monitoring and high-resolution manometry (HRM). They were divided into acid reflux, non-acid reflux, and no reflux groups, with basal impedance (BI) measurements taken at 3, 9, and 15 cm along the esophagus. These values were compared against data of healthy volunteers to identify significant differences across groups.
The acid reflux group displayed a median impedance of 1152 Ω at 3 cm, which was significantly lower than the median impedance of the non-acid reflux group (2644 Ω) and the no-reflux group (3083 Ω) ( = 0.015). Most patients in non-acid reflux and no-reflux groups showed higher impedance levels at both 3 cm and 15 cm compared to the first quartile of healthy individuals with significant differences ( = 0.032 and = 0.029, respectively). Proximal BI was significantly lower than distal BI in both groups: 2278 Ω vs 2644 Ω in the non-acid reflux group ( = 0.035) and 2387 Ω vs 3083 Ω in the no-reflux group ( < 0.001).
Reduced proximal BI values compared to distal BI values suggest increased permeability in globus patients. Further studies with a larger cohort of refractory PPI patients and healthy volunteers are needed to explore these findings and their implications on globus etiology.
背景/目的：癔球症常与胃食管反流病相关，这会影响其治疗策略。本研究旨在调查难治性质子泵抑制剂（PPI）所致癔球症患者的临床特征，以更好地了解其病因。
2017年至2023年期间，对三星医疗中心门诊592例癔球症患者中122例对8周PPI治疗无反应的患者进行了分析。患者接受了24小时食管pH监测和高分辨率测压（HRM）。他们被分为酸反流、非酸反流和无反流组，并在食管3、9和15厘米处进行基础阻抗（BI）测量。将这些值与健康志愿者的数据进行比较，以确定各组之间的显著差异。
酸反流组在3厘米处的中位阻抗为1152Ω，显著低于非酸反流组（2644Ω）和无反流组（3083Ω）（P = 0.015）。与健康个体第一四分位数相比，非酸反流组和无反流组的大多数患者在3厘米和15厘米处的阻抗水平更高，差异有统计学意义（分别为P = 0.032和P = 0.029）。两组近端BI均显著低于远端BI：非酸反流组为2278Ω对2644Ω（P = 0.035），无反流组为2387Ω对3083Ω（P < 0.001）。
与远端BI值相比，近端BI值降低表明癔球症患者通透性增加。需要对更大队列的难治性PPI患者和健康志愿者进行进一步研究，以探索这些发现及其对癔球症病因的影响。
