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  2. A lump in the throat:...
  3. A lump in the throat: laryngopharyngeal reflux
Practice 10-Minute Consultation

A lump in the throat: laryngopharyngeal reflux

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m4091 (Published 02 November 2020) Cite this as: BMJ 2020;371:m4091
  1. Nick J I Hamilton, NIHR clinical lecturer in otorhinolaryngology1 2,
  2. Jane Wilcock, general practitioner3,
  3. Saiful Alam Hannan, consultant otorhinolaryngologist1
  1. 1Royal National Ear Nose & Throat Hospital, London, UK
  2. 2UCL Head & Neck Academic Centre, London, UK
  3. 3Silverdale Medical Practice, Salford, UK
  1. Correspondence to: NJI Hamilton nick.hamilton{at}ucl.ac.uk

What you need to know

  • Globus from laryngopharyngeal reflux (LPR) classically occurs when swallowing saliva and not when eating or drinking

  • First line treatments include lifestyle measures, proton pump inhibitors, and sodium alginate liquids

  • A cancer pathway referral should be considered if there are associated persisting symptoms including pain, swallowing difficulty, or change in voice

Laryngopharyngeal reflux (LPR) is a common condition accounting for approximately 10% of all “ear, nose and throat” (ENT) referrals.1 It is caused by gastric contents passing up through the oesophagus and upper oesophageal sphincter resulting in macroscopic and microscopic inflammatory changes to the upper aerodigestive mucosa.2 This most commonly leads to the sensation of a lump in the throat, termed globus pharyngeus (box 1), as well as chronic throat clearing, excessive mucus, vocal hoarseness, and cough.3 This article offers an overview of the assessment and management of LPR.

Box 1

Globus pharyngeus

  • Globus is Latin for sphere

  • Globus pharyngeus is a descriptive term for the sensation of a lump in the throat and does not imply the diagnosis

  • Globus can be caused by a wide range of throat disorders, the most common being laryngopharyngeal reflux

  • Globus hystericus describes a sensation of a lump in the throat caused by stress. It used to be the preferred term for globus before organic causes such as LPR were found to be causative and should no longer be used

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What you should cover

  • Is the sensation of the lump in the midline or lateralised in a fixed position? The sensation of a lump in the throat from LPR tends to be felt in the middle of the throat, around the larynx, although it can present with changing locations. Fixed lateralised symptoms are more concerning for a throat cancer. The likelihood of an isolated, unexplained sensation of a lump in the throat leading to a cancer diagnosis is low, however, …

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