title: Functional Esophageal Disorders.
abstract: Functional esophageal disorders consist of a disease category that present with esophageal symptoms (heartburn, chest pain, dysphagia, globus) not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, EGJ outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease (GERD). While mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function. Treatments directed at improving borderline motor dysfunction or reducing reflux burden to sub-normal levels have limited success in symptom improvement. In contrast, strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful. However, outcome data from these treatment options are limited. Future research needs to focus on understanding mechanisms underlying visceral hypersensitivity and hypervigilance so that appropriate targets and therapies can be developed.
authors.affiliation: Barts and The London School of Medicine and Dentistry, Professor, Wingate Institute of Neurogastroneterology, Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London UK, London UK.
authors.forename: Qasim
authors.initials: Q
authors.lastname: Aziz
authors.affiliation: MetroHalth Medical Center, The Esophageal and Swallowing Center, Professor, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.affiliation: Division of Gastroenterology, Professor, University Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: C Prakash
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: Division of Upper Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Miwa
authors.affiliation: Chief and Professor, Division of Medicine-Gastroenterology and Hepatology, Feinberg School of Medicine Center, Northwestern University, Chicago, Illinois, USA. Electronic address: j-pandolfino@northwestern.edu.
authors.forename: John E
authors.initials: JE
authors.lastname: Pandolfino
authors.affiliation: CHU de Bordeaux, Professor, Gastroenterology Department, Université de Bordeaux, Bordeaux, France.
authors.forename: Frank
authors.initials: F
authors.lastname: Zerbib
keywords: Rome IV; chest pain; dysphagia; esophageal motility disorders; gastroesophageal reflux disease; globus; heartburn