TY - JOUR
T1 - Esophageal disorders
AU - Aziz, Qasim
AU - Fass, Ronnie
AU - Gyawali, C. Prakash
AU - Miwa, Hiroto
AU - Pandolfino, John E.
AU - Zerbib, Frank
N1 - Publisher Copyright:
© 2016 by the AGA Institute.
PY - 2016/5/1
Y1 - 2016/5/1
N2 - Functional esophageal disorders consist of a disease category that presents with esophageal symptoms (heartburn, chest pain, dysphagia, globus) that are not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, esophagogastric junction outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease. Although mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function. Treatments directed at improving borderline motor dysfunction or reducing reflux burden to subnormal levels have limited success in symptom improvement. In contrast, strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful. However, outcome data from these treatment options are limited. Future research needs to focus on understanding mechanisms underlying visceral hypersensitivity and hypervigilance so that appropriate targets and therapies can be developed.
AB - Functional esophageal disorders consist of a disease category that presents with esophageal symptoms (heartburn, chest pain, dysphagia, globus) that are not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, esophagogastric junction outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease. Although mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function. Treatments directed at improving borderline motor dysfunction or reducing reflux burden to subnormal levels have limited success in symptom improvement. In contrast, strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful. However, outcome data from these treatment options are limited. Future research needs to focus on understanding mechanisms underlying visceral hypersensitivity and hypervigilance so that appropriate targets and therapies can be developed.
KW - Chest Pain
KW - Dysphagia
KW - Esophageal Motility Disorders
KW - Gastroesophageal Reflux Disease
KW - Globus
KW - Heartburn
KW - Rome IV
UR - http://www.scopus.com/inward/record.url?scp=84964757089&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2016.02.012
DO - 10.1053/j.gastro.2016.02.012
M3 - Article
C2 - 27144625
AN - SCOPUS:84964757089
VL - 150
SP - 1368
EP - 1379
JO - Gastroenterology
JF - Gastroenterology
SN - 0016-5085
IS - 6
ER -