Functional esophageal disorders: a review of diagnosis and management

Functional esophageal disorders are a group of conditions that present with symptoms presumed to originate in the esophagus and otherwise not detected in an objective manner with available diagnostic tests. The diagnosis is typically made after the exclusion of gastroesophageal reflux disease and a primary esophageal motility abnormality such as achalasia or distal esophageal spasm. Functional heartburn, functional chest pain of presumed esophageal origin, functional dysphagia and globus are the four functional esophageal disorders as defined in the ROME III consensus criteria. The dietary, pharmacological and psychological therapies that are used for managing these difficult-to-treat conditions are based on limited evidence as of this date. Although diagnostic algorithms can separate hypersensitive esophagus from functional esophageal disorders, a therapeutic and most likely a pathophysiologic overlap between these conditions may exist. In this comprehensive review, the authors present an overview of diagnostic approaches to each of these functional esophageal disorders and summarize available evidence on existing management strategies.