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Chronic globus sensation due to inlet patch –

new endoscopic treatment

Chronic globus sensation due to inlet patch – new endoscopic treatment

A non-invasive treatment

for globus is now available

at London Bridge Hospital,

which is changing the way the

condition is treated.

Chronic globus sensation is defined as

a persistent or intermittent non-painful

sensation in the throat, lasting for three

months. It is derived from the Greek

‘globus pharyngeus’ which means ‘ball

in throat’. It is generally unaccompanied

by problems with swallowing

(dysphagia). Chronic globus sensation

is a common presenting symptom to

primary care, and accounts for one in 20

referrals to Ear, Nose and Throat clinics.

One cause is the cervical inlet patch.

This is an area of aberrant stomach

lining at the proximal end of the

oesophagus, in very close proximity

to the vocal cords. The stomach lining

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retains its normal function, to produce

acid and mucus, and due to its position

this can irritate the back of the throat

and cause globus, as well as cough,

hoarseness and sore throat. It is

estimated that one in 10 people are

born with an inlet patch, though not all

have symptoms. It is thought to affect

men and women equally, and typical

presentation is between 40-60 years

old, though can be younger. Treatments

with conventional anti-acid medication

can be helpful, although often this has

no effect on mucus production and

therefore symptoms persist.

Radiofrequency Ablation (RFA) is a

technique that uses an electrode

mounted either on a balloon or

endoscope, and enables the

endoscopist to destroy the lining of the

oesophagus by tissue vaporisation.

Once the abnormal lining is removed,

the mucosa that regrows is usually

References

1. Dunn, JM et al. RFA of symptomatic cervical inlet patch using a TTS device – a pilot study. Gastrointestinal Endoscopy 2016 epub.

normal squamous lining. This technique

has become the first line treatment for a

condition called Barrett’s Oesophagus,

when dysplasia is present, and was

introduced to London Bridge Hospital

by Dr Jason Dunn, Consultant

Gastroenterologist at Guy’s and St

Thomas’ NHS Foundation Trust Hospital,

last year.

Dr Dunn has recently published the

first study using this technique for inlet

patch, with promising results.

1

All ten

patients had significant improvement

or resolution of the inlet patch, and the

majority (80%) had complete symptom

resolution. The benefit of the technique

is that it is performed under sedation as

a day case, and no surgery is involved

so there is no scarring. Aside from a sore

throat for a few days, no side effects

were reported. This technique is covered

by insurance companies, but not

currently available in the NHS.

AFTER TWO MONTHS, A FURTHER

SESSION OF TREATMENT WAS

UNDERTAKEN, BUT ALREADY

AL HAD NOTED A SIGNIFICANT

IMPROVEMENT IN SYMPTOMS.