Functional dysphagia

Dysphagia is the sensation of food sticking or abnormal bolus transit between the mouth and the stomach. Esophageal-type dysphagia can be distinguished from oropharyngeal dysfunction with a careful history and videofluoroscopy. Structural and motor etiologies of esophageal-type dysphagia can be identified with endoscopy, barium esophagography, esophageal manometry, and functional lumen imaging probe. When no structural abnormalities or motility disorders are present, dysphagia could be related to increased esophageal perception of normal esophageal transit, which is termed functional dysphagia or nonobstructive dysphagia. Functional dysphagia is the least common of the functional esophageal disorders, and may be encountered more frequently in the presence of reflux disease, psychological disorders, hypervigilance and catastrophization, and other functional disorders. Management consists of behavior modification to facilitate swallowing and esophageal transit, a trial of proton pump inhibitors, neuromodulators, and psychological approaches including cognitive and behavioral therapy, and gut-directed hypnotherapy.