Upper esophageal sphincter tone and reactivity to stress in patients with a history of globus sensation

Anxiety and abnormal upper esophageal sphincter function have been ascribed ill- defined roles in the etiology of globus sensation. In this study, we examined the psychological profile and effect of acute mental stress (dichotic listening task) on UES tone in seven patients reporting to the clinic with globus sensation and 13 healthy controls. Alterations in heart rate, blood pressure, frontalis EMG, and skin conductance confirmed the effectiveness of the stress test in patients and controls. During resting conditions, UES pressure (mean±SE) in patients (40.4±4.6 mm Hg) did not differ significantly from controls (46.5±4.7 mm Hg). In response to stress, UES pressure rose by 31% in patients (P=0.04) and by 25% in controls (P=0.002). The stress- induced rise in UES pressure in patients (9.5±3.8 mm Hg) was not significantly different to that observed in controls (11.8±3.0 mm Hg). Psychological profiles of globus patients presenting to the clinic revealed them to be more introverted, anxious, neurotic, and depressed than normal controls. We conclude that in patients with a history of globus sensation, resting UES pressure and its response to stress is normal. Although individuals presenting to the clinic with globus sensation showed increased levels of psychoneurosis, acute, predictable stress is not a factor in the genesis of globus sensation. UES hyperresponsiveness to other stimuli or subjective intolerance to changes in UES pressure could account for symptoms of globus sensation.Dr. Cook is supported by a University of Sydney, Postgraduate Medical Foundation Award. Dr. Dent was supported as a Visiting Professor to McMaster University by a Visiting Scientist Award from the Canadian Medical Research Council.