Functional esophageal disorders: pharmacological options

Functional esophageal disorders are a group of disorders that cause esophageal symptoms, although with negative results on investigation with standard esophageal tests. Therefore, structural disorders, motility disorders with a histopathological basis and gastroesophageal reflux disease (GERD) are excluded. They are frequently encountered by clinicians, and so a systematic and evidence-based approach to investigation, diagnosis and treatment are crucial. There are four functional esophageal disorders defined by the ROME III consensus, namely functional heartburn, functional chest pain, functional dysphagia and globus. Since the advent of ROME, the specification of diagnostic criteria for functional esophageal disorders has allowed more comparable studies and clinical trials. Despite this, the evidence base for many therapies in use at present is not as robust as would be desired. In this paper, we discuss the four categories of functional esophageal disorders. We then propose diagnostic algorithms based on current evidence. Finally, we discuss current therapies for each of the four functional esophageal disorders based on current evidence.