{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 1, Ep 2 of 3: Globus, Rumination, and Odynophagia","html":"","width":"100%","height":180,"duration":693,"description":"Episode two of the Esophageal Symptoms chapter covers the complaints that aren't classic dysphagia: globus, rumination, supragastric belching, functional chest pain, and painful swallowing. The unifying tell is a reflux-looking patient who fails real acid suppression, which means the problem was never acid. Diagnosis is made from the history and exposures; the test only confirms it.\n \nTopics covered\n\nGlobus sensation\nRumination syndrome\nSupragastric belching\nFunctional chest pain\nFunctional heartburn and reflux hypersensitivity\nOdynophagia workup\nPill esophagitis\nInfectious esophagitis\n \n \nKey decisions\n\nA reflux-looking patient who fails a real dose of PPI is telling you the problem is not acid; stop escalating and rethink the diagnosis.\nGlobus improves or stays unchanged with swallowing while true dysphagia worsens; workup stays narrow and reassurance is the treatment.\nRumination is effortless postprandial regurgitation of recognizable food with no retching, confirmed by postprandial impedance-manometry showing abdominal and esophageal pressure rising together; treat with diaphragmatic breathing, not more PPI or fundoplication.\nFunctional chest pain is treated with a low-dose tricyclic neuromodulator (imipramine or amitriptyline 25 to 50 mg at bedtime), not a higher PPI dose.\nPill esophagitis causes discrete, often kissing ulcers at the aortic arch level; classic offenders include doxycycline, potassium chloride, bisphosphonates, NSAIDs, and iron; treat by stopping the drug and correcting pill technique.\nHerpes ulcers are shallow with volcano edges and viral cytopathic changes at the edge, so biopsy the edge; CMV ulcers are large, deep, and punched-out with owl-eye inclusions at the base, so biopsy the base.\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}