IntroductionFunctional Esophageal Disorders
Section snippets
Definition
Retrosternal burning in the absence of GERD that meets other essential criteria for the functional esophageal disorders typifies this diagnosis. Constraints in the ability to fully recognize the presence or importance of GERD in individual subjects likely result in a heterogeneous subject group.1
Epidemiology
Heartburn is reported by 20%–40% of subjects in Western populations, depending on thresholds for a positive response. Studies using both endoscopy and ambulatory pH monitoring to objectively establish
Definition
This disorder is characterized by episodes of unexplained chest pain that usually are midline in location and of visceral quality and therefore potentially of esophageal origin. The pain easily is confused with cardiac angina and pain from other esophageal disorders, including achalasia and GERD.
Epidemiology
Inferential data extracted from cardiac evaluations for chest pain indicate that this is a common disorder. Findings on 15%–30% of coronary angiograms performed in patients with chest pain are normal.13
Definition
The disorder is characterized by a sensation of abnormal bolus transit through the esophageal body. Thorough exclusion of structural lesions, GERD, and histopathology-based esophageal motor disorders is required for establishing the diagnosis.
Epidemiology
Little information is available regarding the prevalence of functional dysphagia, largely because of the degree of exclusionary evaluation required. Between 7% and 8% of respondents from a householders survey reported dysphagia that was unexplained by
Definition
Globus is defined as a sense of a lump, a retained food bolus, or tightness in the throat. The symptom is nonpainful, frequently improves with eating, commonly is episodic, and is unassociated with dysphagia or odynophagia. Globus is unexplained by structural lesions, GERD, or histopathology-based esophageal motility disorders.
Epidemiology
Globus is a common symptom and is reported by up to 46% of apparently healthy individuals, with a peak incidence in middle age.14 It is uncommon in subjects younger than
Recommendations for Future Research
Despite their high prevalence rates, functional esophageal disorders have not been well studied. In particular, highly effective management approaches have not been established. Several areas requiring additional research were identified.
- 1
Studies validating the diagnostic criteria are needed, and a method for improving the accuracy of symptom-based criteria while limiting exclusionary workup would be welcomed.
- 2
The fundamental mechanisms of symptom production remain poorly defined. Further
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