Relationship between globus sensation and esophageal clearance abnormalities in an elderly group

Recent studies suggest that gastroesophageal reflux disease (GERD) may be a cause of globus sensation. However, it is difficult to examine the reflux of acidic gastric contents directly. We hypothesized that the esophageal clearance capacity against reflux acid may be responsible for the clinical symptoms of GERD. The purpose of this study was to investigate the bolus residue and reflux in the esophagus during swallowing in elderly patients and to discuss the relationship between globus sensation and esophageal clearance abnormalities. Videopharyngoesophageal examinations in the prone position were performed in 156 elderly patients with globus sensation (average age: 74.7 years old). Esophageal clearance in the prone position was classified into 4 subgroups according to the movement of a contrast bolus: Group 1, normal; group 2, retension in esophagus; group 3, reflux of contrast bolus within esophagus; group 4, reflux of contrast bolus into pharyngo-laryngeal regions. Group 1 contained 36 cases (23.1%), group 2 contained 8 cases (5.1%), group 3 contained 79 cases (50.6%), and group 4 contained 33 cases (21.2%). Overall, the reflux of a contrast bolus in the esophagus was observed in 112 cases (71.8%). We concluded that decreased esophageal clearance in elderly subjects affects the defense mechanism against acid exposure and may be a risk factor for the appearance of globus sensation. Videopharyngoesophageal examination in the prone position may be an easy and valuable method for evaluating the function of esophageal clearance.