lecture describing the esophageal symptoms such as heartburn without organic causes

1. Functional esophageal
disorders
Dr Yasser M Fouad

2. Gastroenterology 2006

3. Causes
 Motility disorder
 Visceral sensory abnormalities:
- acid
- distention
 Psychological factors:
-Anxiety, somatization and depression

4. Functional esophageal disorders
 Functional heartburn
 Functional dysphagia
 Functional chest pain
 Functional globus

5. Functional heartburn
 Burning Retrosternal pain or discomfort
 Absence of GERD
 Absence of motility disorders
 For at least 3 months with 6 months onset

7. Treatment
 Tricyclic antidepressant
 Promotility drugs
 SSRI

8. Functional Chest pain
 Midline chest pain or discomfort that is not of
burning quality
 2. Absence of evidence that gastroesophageal
reflux is the cause of the symptom
 3. Absence of histopathology-based esophageal
motility disorders
 Criteria fulfilled for the last 3 months with symptom
onset at least 6 months before diagnosis

9. Treatment
 Antidepressants
 Botulinum toxin injection

10. Functional Dysphagia
 1. Sense of solid and/or liquid foods sticking,
lodging, or passing abnormally through the
esophagus
 2. Absence of evidence that gastroesophageal
reflux is the cause of the symptom
 3. Absence of histopathology-based esophageal
motility disorders
 *Criteria fulfilled for the last 3 months with symptom
onset
 at least 6 months before diagnosis

11. Globus
 1. Persistent or intermittent, nonpainful sensation
of a lump or foreign body in the throat
 2. Occurrence of the sensation between meals
 3. Absence of dysphagia or odynophagia
 4. Absence of evidence that gastroesophageal reflux
is the cause of the symptom
 5. Absence of histopathology-based esophageal
motility disorders
 *Criteria fulfilled for the last 3 months with symptom
onset at least 6 months before diagnosis

12. Promotility agents
 Metoclopramide
 Erythromycin
 Tegaserod
 Dompridone
 Mosapride

13. Psychotropic agents
 Tricyclic antidepressants
 Selective serotonin reuptake inhibitors
 Benzodiazepines

14. Psychotherapy
 Cognitive behavioral therapy
 Relaxation therapy
 Hypnosis
 Psychodynamic therapy

15. Alternative Therapies
 Common alternative therapies include
acupuncture, massage therapy, herbal
remedies, hypnotherapy, therapeutic touch,
aromatherapy, and color therapy.