Functional esophageal disorders

The functional esophageal disorders include globus, rumination syndrome, an d symptoms that typify esophageal diseases (chest pain, heartburn, and dysp hagia). Factors responsible for symptom production are poorly understood. T he criteria for diagnosis rest not only on compatible symptoms but also on exclusion of structural and metabolic disorders that might mimic the functi onal disorders. Additionally, a functional diagnosis is precluded by the pr esence of a pathology-based motor disorder or pathological reflux, defined by evidence of reflux esophagitis or abnormal acid exposure time during amb ulatory esophageal pH monitoring. Management is largely empirical, although efficacy of psychopharmacological agents and psychological or behavioral a pproaches has been established for serveral of the functional esophageal di sorders. As gastroesophageal reflux disease overlaps in presentation with m ost of these disorders and because symptoms are at least partially provoked by acid reflux events in many patients, antireflux therapy also plays an i mportant role both in diagnosis and management. Further understanding of th e fundamental mechanisms responsible for symptoms is a priority for future research efforts, as is the consideration of treatment outcome in a broader sense than reduction in esophageal symptoms alone. Likewise, the value of inclusive rather than restrictive diagnostic criteria that encompass other gastrointestinal and non-gastrointestinal symptoms should be examined to im prove the accuracy of symptom-based criteria acid reduce the dependence on objective testing.