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Functional esophageal disorders / Functional dysphagia
Functional dysphagia
Barium radiography with radio-opaque bolus challenge (e.g., barium pill or marshmallow) and fluoroscopy can help to identify both the anatomic level and the nature of the obstructing lesions(2).
Endoscopy is essential to identify tumors, mucosal rings, structures, and/or evidence of pathologic reflux(2). Biopsies at the time of endoscopy are recommended for excluding eosinophilic esophagitis(1).
Negative evaluations should be followed by manometry(2). Outpatient pH monitoring plays a modest role, though may be helpful in patients whose dysphagia is associated with heartburn or regurgitation(1). A brief therapeutic trial with a high-dose proton pump inhibitor (PPI) regimen is usually satisfactory for identifying patients with subtle reflux disease as a cause for dysphagia(13).
This disorder is characterized by a sensation of abnormal bolus transit through the esophagus(1). Dysphagia is regarded as being functional when there is no structural abnormalities, pathological reflux (GERD), or histopathology-based esophageal motor disorders to explain the symptom(2). The diagnosis is restricted to patients with esophageal rather than oropharyngeal dysphagia, the hallmark symptom being the aforementioned sensation of abnormal bolus transit through the esophagus(2).
Rome III diagnostic criteria* for functional dysphagia(1):
| Must include all of the following: | |
| 1. | Sensation of solid and/or liquid food that sticks, lodges, or abnormally progresses through the esophagus. |
| 2. | No evidence of gastroesophageal reflux as the cause of the symptom. |
| 3. | Absence of histopathology-based esophageal motility disorders. |
*Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis
Dysphagia is not easily linked to reflux events. Nevertheless, the changes on the threshold used for the second criterion would attribute the symptom to GERD rather than to a functional diagnosis should such a link be established, even in the absence of other objective GERD indicators(1).
Careful exclusion of structural lesions is essential before establishing a functional diagnosis(2). ]
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