2. Globus / W.G. Thompson

Globus hystericus; lump in the throat. 

Globus is a lump in the throat or a perceived inability to swallow unassociated with meals. Nearly one out of every two persons experiences this symptom, often at the time of an intense emotional experience. 

Globus is a "functional" disorder since no pathologic or pathophysiologic abnormality has been clearly identified. Many believe that globus is due to a dysmotility of the upper esophageal sphincter. 

Generally speaking, patients with globus can swallow meals normally but feel an inability to swallow their saliva between meals. The tendency of globus to occur when the patient is experiencing intense emotion has led in the past to the use of the epithet "globus hystericus." Since one-half of the population experiences this symptom, the term hystericus hardly seems justified. Patients may have psychogenic features such as anxiety, but are not overt in displaying other conversion features. There are no physical findings. 

Globus is easily distinguished from true dysphagia by its occurrence between meals and by the lack of difficulty in swallowing such items as bread and meat. The sensation is continuous. 

There is no treatment beyond reassurance. No diagnostic tests are indicated. Deep-seated emotional features may warrant a psychiatric opinion.