[Differential diagnosis of psychosomatic deglutition disorders]

Symptoms of dysphagia and chronic vomiting often are categorized as being elicited by psychogenic factors, when no explanation can be found by fluoroscopic and endoscopic means. Psychogenic factors were also thought to be of aetiological significance in 58 patients referred under the diagnoses "psychogenic", "psychosomatic", and "functional" swallowing disorder, "psychogenic vomiting", "conversion neurosis", "anorexia nervosa", "psychosomatic disturbances in pregnancy", "cancer phobia", "cardiac phobia (DaCosta syndrome)", and "depressive disorder" to the Psychophysiology Unit, University of Vienna, for further evaluation. However, manometric, pH-metric, and endoscopic investigations showed that all of these patients suffered in fact from organic disorders: 36 from achalasia, 5 from vigorous achalasia, 5 from diffuse oesophageal spasms, 6 from lower oesophageal contraction abnormalities, one from pharyngo-oesophageal dyscoordination, one from a gastric ulcer ad cardiam, and 4 from gastro-oesophageal refluxes of whom one also had a hypertonic upper oesophageal sphincter. These findings, together with the fact that all concepts relating swallowing disorders to psychogenic factors have remained purely speculative, show that it is not justifiable to label dysphagic symptoms, for which no organic aetiology can be detected, as "psychogenic" or "psychosomatic". Patients with such symptoms should be studied by means of oesophageal manometry and/or pH-metry to reveal the nature of their disorder and to enable adequate therapy.