Thought I had Globus Hystericus from anxiety, now it looks like LPR?

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Hi everyone, I'm new here!

I amd 31, and have suffered from chronic anxiety for 15 years. I've had a variety of physical symptoms, the worst being Globus Hystericus, the lump in the throat feeling. This probably started 5 years ago or more, and was on and off. It seemed to come in times of anxiety more, and varied in intensity. There were times where it seemed to last for months, and was all I could think about. I realise now Ive learned to live with an almost constant pain. 

I have done a lot of work on myself, therapy, mediation, lifestyle changes. I had some relief for months last year, and forgot all about it!  Then recently it has come back with a vengeance.  It really is debilitating. I tend to burp a lot when having these bouts, and get a burning sensation in my diaphragm, which I am guessing is acid at the bottom of my oesopheagus. 

I honestly always assumed it was just anxiety causing all this, and that if I managed my anxiety it would go away. This idea just caused me more anxiety! And yes the anxiety does make it worse even if it is not the cause.

Recently I started losing my voice a lot, just from talking, and even from a few minutes, and especially from singing. (I make music for a living).  I then googled a bit more about lump in the throat and hoarseness, and it came up with LPR! I have almost all of the symptoms, and it matches perfectly.

Does this sound more correct than Globus Hystericus?

I now am wondering what route to take, which is why I am asking your advice. Also, does it sound like i have diagnosed myself correctly?  I am prepared to make drastic changes to get on top of this, and would rather aboid just symptomaic relief with drugs. I am wondering if I need to take omperazole, or similar?  It sounds like they dont help many people. And also Gaviscon, could this help in the short term?

 I have tried to get help from the doctor, and they have been useless. I cant even get reffered to an ENT. I might have to go private.

I'm not asking for a cure, as I know there isnt one. I think I am more looking for advice on my particular situation or any general help.....and any advice would be greatly appreciated

Thanks

Alex

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13 Replies

  • Posted

    Globus, and the other symptoms you describe, are most probably due to reflux and acid.

    Globus is reported by 50% of those with extra-oesophageal reflux (also known as "LPR" ) . See the www DownWithAcid org uk free book / website and fnd the chapter on extra-oesohageal reflux in the reflux section.

    If you are refluxing acid, you should be taking acid suppressant medication (usually a PPI like omeprazole). This will ensure the reflux is less harmful. Acid refluxing may cause permanent damage to your oesophagus (Barrett's Oesophagus) which has the ability in some people to mutate to cancer.

    Although PPIs are excellent at reducing acid and are probably chemo-protect to help reduce the risk of developing cancer, they may not reduce your reflux. 

    You will need to manage the reflux by lifestyle, though:

    Lose weight if necessary. Stop smoking if appropriate. Avoid tight clothing. Avoid exercise that constricts the stomach after eatng. Do not overfill your stomach - eat little and often. Leave at least 3 hours between last meal and going to bed. Raise the head of your bed by 6 to 8 inches on blocks. 

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    • Posted

      Dear Barrets,

      ​Some questions for you. You had a surgery done isn't it?

      ​1. Where your problems also the ones of LPR?

      ​2. Did you also had frequent belching/burping?

      ​3. Did you also had TLESRs?

      4. And did the operation solve these problems too? Ive read that the sugery is especially interesting for suspine and not for upright. And that the belching isn't much reduced...

      ​Thanks in advance.

       

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    • Posted

      I had my problems all my life. I can recall incidences from when I was 3 that I now know to have been reflux. It wasn't util I was 50 that this was recognised.

      Then, 15 years ago, my symptoms were all reflux, the acid having been suppressed with omeprazole.

      My worst symptom was the cough, the throat clearing. I also had blocked ears, blocked nose, dry eyes, dysphagia (swallowing difficulty), globus, etc.

      Transient Lower oEsophageal Sphincter Relaxations are quite natural and normal for everyone. We're meant to be able to burp - when we are upright. The muscles that comprise the lower oesophageal sphincter are meant to keep it closed when we recline.

      The operation solved all these problems - but I still burp.

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    • Posted

      Thats a lot worse than I'm experiencing. Great it all solved.

      TLESRs are normal indeed. A way to vent gas. But I have them about each 10 tot 15 minutes when I’m upright. I dont think that’s quite normal and it leads to burping all the time. Which gives a sore throat. And after the stomach seems to be out of air, the acid seem to come up with the belching, given heartburns. Even after lifestyle changes and acid reducing diets.

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  • Posted

    The first thing you need to do is have an Endoscopy (GI) and Laryngoscopy which will check the back of your throat/vocals for irritation which is suggested of Reflux (ENT). Having doubts is not going to help your anxiety (I guess you know that) and start implementing the changes Barretts suggested. Just like you I appear to have both, and I have done just about all the test in the book.  Tomorrow I'm due for a esophageal manometry which I'm looking forward 2 and I'm not looking forward 2. ;-) 
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  • Posted

    Hi guys

    Thanks for the quick replies. It does seem to fit the bill very well. In one way it feels a relief to think it could be LPR, as before when I thought it was purely anxiety it was such a pressure just to relax, and that didnt help me be relaxed!

    I have read such conflicting info on PPIs, that Im worried about taking them. I am in Thailand and have bought some Omerprazole. I really cant decide whether to take it or not. Are any of the PPIs better tha others, omeprazole vs esomprazole etc.  And in what dosage, because it seems it varies a lot.

    I think you are right, I need to get the tube down the throat and see. As my problems seem to flare up for a while, losing my voice, lump, soreness etc, and then dissapear occasionally, does it matter when I have the Endoscopy?  Should I do it during a flare up?

    Thanks guy, really appreciate it

    Alex

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    • Posted

      The research has shown all  PPIs are as effective as each other when taken in equivalent dose (despite what the manufacturers try to make us believe). But some patients tolerate one more than another. As long as you use the drugs correctly - taken pre-emptively at the same time every day (half an hour before breakfast is best) and smallest effective dose for shortest possible time, you should have no problems.

      Normal maintenance dose of omeprazole is 20mg. If you need them for more than about 4 weeks, make sure it is being monitored by a doctor.

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  • Posted

    Hi Barretts

    Thank you. So are PPis normally a prescription medicine in the UK?

    I can get anything here in Thailand myself, but obviously would like to follow the usual routine. I have Omeprazole, so maybe I should start with that. I hear about people being on these drugs for years.....what do you mean by the shortest possible time, are you meant to stop when symptoms decrease, if they decrease?

     

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    • Posted

      Without a proper diagnosed you should not take it for more than 4 weeks.  It won't hurt to try them for that short time. Now, if they do help I suggest you get medical approval.  PPi's will help with the symptoms and blocking some acid but they are not a cure.   So you will still need the tests done which you can have at any time (the sooner the better).  You can have low acid and have the same symptoms so taking PPI's will just make it worse plus maybe add more problems like Vitamin deficiencies to start with. ;-(
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    • Posted

      PPIs always were prescription only but Astra Zeneca used their migt to make Nexium available off the shelves of our supermarkets. Bad move. That lead to problems in USA which is what has given PPIs a bad name.

      They are very safe drugs if taken correctly - and that really means being monitored.

      Many people have to take them for life. I was on them for 15 years until I had a fundolication and no longer need them.

      If you find taking them for a few weeks stops the symptoms, then stop. If you still need them, discuss with a doctor.

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  • Posted

    Hi guys

    Thanks again for the information, its really useful.

    I was just wondering about something to do with the throat sensations, that I only realised properly last night....

    There are times in the night especially when I wake up and feel like my throat is actually closing up. I realised I have some conscious ability to relax it. Only slightly. If you imagine closing your throat up on purpose, as if to speak in a silly voice, it feels like I wake up like that, and I can just about bring it back apart. I also get a lot of tension at the back of my tongue, and I can never seem to get rid of that.  Does this still sound like LPR symptoms, does it go to the tongue, and if I can control the throat consciously a biut, does that not mean it is actually muscular rather than irritated? Or maybe its both, Im so confused. 

    I only slept a couple of hours last night, and now anxiety is high.

    When do you guys take gaviscon?  It says on the packet whenever you feel heartburn etc. But do any of you take it routinely to fight the constant LPR symptoms?

    Thanks again, really have been quite worried

    Alex

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  • Posted

    From what I can find, people dont seem to have much luck with omeprazole, and many peopl esay they experienced negative side effects, or reflux being worse when stopping etc.

    I just saw astudy that said it wasnt any more effective than a placebo in relieving symptoms.

    I know what I need to do with my diet etc. I am just still on the fence about taking the PPIs. You guys seem to say that I should, but theres such mixed info out there. I wonder if worth seeing a doctor and getting a diganosis first, not that doctors have helped me much in the past!

    Thanks again

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