Multidisciplinary Assessment and Management of Functional Dysphagia

Functional dysphagia (FD), a type of functional esophageal disorder, is characterized by difficulty passing solid and/or liquid food through the esophagus, without underlying mucosal, luminal, or major motility diseases, as defined by the Rome IV criteria. It is also a type of functional gastrointestinal disorder (FGID), which are disorders of gut-brain interaction (DGBI). The underlying mechanism is thought to involve a complex interaction between the gut and central nervous system (CNS), where altered gut signaling may lead to visceral hypersensitivity, while CNS dysregulation may cause hyper-vigilance, potentially contributing to motor disturbances. There is no standardized approach to the evaluation of FD and historically, it has been considered a diagnosis of exclusion. There is also no standardized treatment algorithm, and most FD treatments are garnered from other FGIDs. As our field gains a deeper appreciation of FGIDs, it is also clear that the management of suspected FD patients requires a multidisciplinary approach. This narrative review not only 1) provides an overview of FD including its definition, epidemiology, pathophysiology, clinical characteristics, associated disorders, multidisciplinary assessment, and treatment, but also 2) details our unique multidisciplinary approach to FD patients from the perspective of gastroenterologists, speech-language pathologists (SLPs), and GI psychologists at the Joy McCann Culverhouse Center for Swallowing Disorders at the University of South Florida (USF CSD).