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Conrad F. Smit, MD; Justin A. M. J. van Leeuwen, MD; Lisbeth M. H. Mathus-Vliegen, MD, PhD; Pieter P. Devriese, MD, PhD; Astrid Semin, RN, MS; Joep Tan, MD, PhD; Paul F. Schouwenburg, MD, PhD

Arch Otolaryngol Head Neck Surg. 2000;126:827-830.

Background  The role of gastropharyngeal reflux in patients with globus pharyngeus and hoarseness remains unclear.

Objective  To evaluate patients with complaints of globus, hoarseness, or globus and hoarseness combined for the presence of gastropharyngeal and gastroesophageal reflux.

Design  Prospective clinical cohort study of 3 groups of patients undergoing ambulatory 24-hour double-probe pH monitoring. In patients with pathologic gastroesophageal reflux, an upper gastrointestinal endoscopy was also performed.

Setting  Tertiary care, outpatient clinic.

Patients  Twenty-seven patients with globus alone, 20 patients with hoarseness alone, and 25 patients with globus and hoarseness combined.

Results  Patients with well-defined pathologic reflux (ie, gastroesophageal reflux with or without gastropharyngeal reflux) were present mainly in the group of patients with globus combined with hoarseness: 18 (72%) of 25 patients, compared with 7 (35%) of 20 patients with hoarseness alone and 8 (30%) of 27 with globus alone. Seven (10%) of all 72 patients had prolonged acid exposure at the laryngopharyngeal junction in the presence of a normal gastroesophageal pH registration. Abnormal findings in the esophagus were found at endoscopy in 17 (65%) of 26 patients with pathologic gastroesophageal reflux (with or without gastropharyngeal reflux).

Conclusions  We found a high prevalence of pathologic reflux in patients with both globus and hoarseness. Based on these findings, we strongly advise upper gastrointestinal endoscopy for symptomatic otolaryngological patients with pathologic gastroesophageal reflux.

From the Departments of Otorhinolaryngology–Head and Neck Surgery (Drs Smit, van Leeuwen, Devriese, Tan, and Schouwenburg), Gastroenterology (Dr Mathus-Vliegen), and Epidemiology and Biostatistics (Ms Semin), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Dr Smit is now with the Department of Otolaryngology–Head and Neck Surgery, University Hospital Vrije Universiteit, Amsterdam.

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