Functional esophageal disorders are conditions characterized by typical esophageal symptoms (chest pain, heartburn, dysphagia, globus) that are not explained by structural abnormalities, major motor disorders, or gastroesophageal reflux disease (GERD). Functional esophageal disorders include functional chest pain, functional heartburn, reflux hypersensitivity, functional dysphagia, and globus.
Although the exact mechanisms responsible for functional esophageal disorders are unclear, it is thought that visceral hypersensitivity (heightened sensitivity of the cells or neurons transmitting sensory information back to the brain) and hypervigilance (central perception of esophageal symptoms) play an important role.
The symptoms vary depending on which functional esophageal disorder is being discussed. All of the disorders require structural abnormalities, major motor disorders, and GERD to be ruled out first. Functional chest pain is characterized by retrosternal chest pain or discomfort. Functional heartburn is characterized by burning retrosternal pain or discomfort that is not relieved with optimal acid suppression therapy. Reflux hypersensitivity is characterized by retrosternal heartburn or chest pain with evidence of symptoms being triggered by reflux events despite normal acid exposure on pH testing. Functional dysphagia is characterized by the sensation of food sticking or feeling of delay in food passage through the esophagus. Globus is characterized by persistent or intermittent, non-painful sensation of a lump or foreign body in the throat without any structural lesion identified on workup.
Functional esophageal disorders are diagnosed based on symptom criteria and the exclusion of structural abnormalities, major motor disorders, and GERD. This workup often includes upper endoscopy, barium swallow, esophageal manometry, and pH testing.
The treatment options for functional esophageal disorders are broad and should be tailored to the individual patient based on the type of functional esophageal disorder and patient preferences. Although functional esophageal disorders are not dangerous or life threatening, they can certainly impact quality of life. There are medications that target neuromodulation of pain. Behavioral treatments such as cognitive behavioral therapy, hypnosis, or relaxation therapy can be utilized. Alternative therapy such as acupuncture is also an option.