Rome IV Diagnostic Criteria for Globus

Rome IV Globus

Persistent or intermittent, non-painful sensation of a lump or foreign body in the throat

Sensation occurs between meals

No dysphagia (difficulty swallowing)

No odynophagia (painful swallowing)

Absence of GERD

Absence of eosinophilic esophagitis

Absence of major esophageal motor disorder

Present for last 3 months with onset ≥6 months prior

Rome IV Assessment: Negative

Criteria Not Met

No criteria met for Rome IV globus.

Official Rome IV criteria for the diagnosis of globus.

Why Use

Helps to make a diagnosis of globus when appropriate workup is otherwise nondiagnostic. Helps to distinguish symptoms from other common disorders. Helps to guide management of symptoms once a diagnosis of globus is established.

When to Use

Patients presenting with symptoms of a persistent or intermittent non-painful sensation of a lump or foreign body in the throat for at least 6 months, which are suggestive of globus. The diagnosis of globus should be made only after structural or inflammatory causes are excluded through careful history and physical examination and/or endoscopic or laryngoscopic examination.

Formula

To fulfill the Rome IV criteria for globus, patient must have the following (for 3 months prior with symptom onset ≥6 months ago with a frequency of at least once a week): Persistent or intermittent, nonpainful, sensation of a lump or foreign body in the throat with no structural lesion identified on physical examination, laryngoscopy, or endoscopy. a. Occurrence of sensation between meals. b. Absence of dysphagia or odynophagia. c. Absence of a gastric inlet patch in the proximal esophagus. Absence of evidence that gastroesophageal reflux or EoE is the cause of the symptom. Absence of major esophageal motor disorders (achalasia/ EGJ outflow obstruction, diffuse esophageal spasm, jackhammer esophagus, absent peristalsis).

Pearls / Pitfalls

The sensation of globus does not occur when eating or drinking. Physical examination of the neck and laryngoscopic evaluation of the pharynx is advised in the initial evaluation of globus symptoms. A trial of proton pump inhibitor (PPI) therapy should be considered. If symptoms of globus persist despite PPI treatment, evaluation with upper endoscopy may be considered, in which case the presence of eosinophilic esophagitis or a gastric inlet patch in the upper esophagus should be excluded. If esophageal manometry is performed, identification of a major esophageal motility disorder (e.g. achalasia, EGJ outflow obstruction, diffuse esophageal spasm, jackhammer esophagus, absent peristalsis) may explain or coexist with globus.

Management

Management of globus may include: Education and patient reassurance. Neuromodulator. Behavioral therapy (e.g. cognitive behavioral therapy, hypnosis).

Critical Actions

This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.

Advice

If diagnostic criteria are not met (negative): Symptoms are unlikely to be caused by globus. Consider further assessment for other diseases, or a different functional GI disorder. If meets diagnosis (positive): Likely diagnosis of globus.