Functional Esophageal Disorders

Abstract

Patients with functional esophageal disorders present with symptoms suggestive of esophageal disease that are not secondary to GERD, major esophageal motility disorders (achalasia, EGJ outflow obstruction, jackhammer esophagus, distal esophageal spasm, and absent contractility), structural abnormality, or histopathological diagnoses (such as eosinophilic esophagitis). Symptoms must be present for the last 3 months with onset of symptoms at least 6 months prior to diagnosis. Esophageal hypersensitivity, abnormal central processing of peripheral stimuli, autonomic dysregulation, hypervigilance, and psychological comorbidity are some of the proposed mechanisms thought to be important in symptom generation of these patients (see Fig. 12.1). The current Rome IV classification of functional esophageal disorders includes functional heartburn, reflux hypersensitivity, functional chest pain, functional dysphagia, and globus, each of which will be described in the following sections. The newest iteration of the Rome criteria takes into account esophageal motor disorders, the wide spectrum of symptoms attributable to eosinophilic esophagitis, mechanical obstructions, and the overlap of functional esophageal disorders with GERD.