Functional esophageal disorders

Dr Yasser M Fouad

Gastroenterology 2006

Causes

Motility disorder

Visceral sensory abnormalities:

- acid

- distention

Psychological factors:

-Anxiety, somatization and depression

Functional esophageal disorders

Functional heartburn Functional dysphagia Functional chest pain Functional globus

Functional heartburn

Burning Retrosternal pain or discomfort Absence of GERD Absence of motility disorders For at least 3 months with 6 months onset

Treatment

Tricyclic antidepressant Promotility drugs SSRI

Functional Chest pain

Midline chest pain or discomfort that is not of

burning quality 2. Absence of evidence that gastroesophageal

reflux is 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

Treatment

Antidepressants

Botulinum toxin injection

Functional Dysphagia

1. Sense of solid and/or liquid foods sticking, lodging, or passing abnormally through the

esophagus 2. Absence of evidence that gastroesophageal

reflux is 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

Globus

1. Persistent or intermittent, nonpainful sensation

of a lump or foreign body in the throat 2. Occurrence of the sensation between meals 3. Absence of dysphagia or odynophagia 4. Absence of evidence that gastroesophageal reflux

is the cause of the symptom 5. Absence of histopathology-based esophageal

motility disorders *Criteria fulfilled for the last 3 months with symptom

onset at least 6 months before diagnosis

Promotility agents

Metoclopramide Erythromycin Tegaserod Dompridone Mosapride

Psychotropic agents

Tricyclic antidepressants Selective serotonin reuptake inhibitors Benzodiazepines

Psychotherapy

Cognitive behavioral therapy Relaxation therapy Hypnosis Psychodynamic therapy

Alternative Therapies

Common alternative therapies include acupuncture, massage therapy, herbal remedies, hypnotherapy, therapeutic touch, aromatherapy, and color therapy.