OVERVIEW

What is functional dysphagia?

Strictly speaking, dysphagia is not a disease but a symptom, one of the clinical manifestations of certain conditions.

The main symptoms of dysphagia include the inability to initiate swallowing or the sensation of obstruction when solids or liquids pass through the esophagus into the stomach. Dysphagia is a subjective feeling of obstruction or abnormality during the swallowing process.

Functional dysphagia is a rare type of dysphagia and is considered an exclusionary diagnosis, meaning all other organic diseases must be ruled out before it can be diagnosed. Currently, there are no effective treatments, but the prognosis is generally favorable.

What are the types of functional dysphagia?

• Based on etiology, dysphagia can be classified as mechanical or motility-related;
  
  
• Based on the location of the difficulty, it can be categorized as oropharyngeal or esophageal.

Is functional dysphagia common?

It is relatively rare, and there is limited data on its prevalence.

What is the difference between functional dysphagia and globus sensation?

Both functional dysphagia and globus sensation are types of functional gastrointestinal disorders (FGIDs). However, functional dysphagia involves actual esophageal dysfunction, while globus sensation is more influenced by emotions and often occurs between meals.

In terms of sensation, patients with globus sensation primarily feel a lump or foreign object in the throat, whereas those with functional dysphagia mainly experience slow food passage, food sticking in the throat, or a sensation of reflux.

SYMPTOMS

What are the manifestations of functional dysphagia?

It may feel like food is swallowed slowly, sticks in the throat, or regurgitates.

At the same time, patients with functional dysphagia may also experience emotional distress. While focusing on symptom relief, don’t forget to take care of your emotions. Lifestyle changes such as meditation and exercise can help improve mood, and psychological counseling can also assist in resolving emotional difficulties.

Additionally, patients at this time greatly need support and understanding, so the care of family and friends can be very helpful to them.

CAUSES

What are the causes of functional dysphagia?

The exact cause is unknown. It may be related to psychological factors such as depression or anxiety.

Is functional dysphagia hereditary?

It remains unclear.

Is functional dysphagia contagious?

Functional dysphagia is not contagious.

DIAGNOSIS

How is functional dysphagia diagnosed?

Its diagnosis is exclusion-based, meaning symptoms like abnormal food adherence, reflux, or slow swallowing in the esophagus are present, but there is no evidence of gastroesophageal reflux disease or esophageal dysfunction with pathological structural abnormalities. However, these sensations must have persisted for at least 6 months before diagnosis and lasted for at least 3 months.

What tests are needed to diagnose functional dysphagia?

There is no definitive test since it is an exclusion-based condition. All examinations for esophageal and oropharyngeal dysphagia must be performed to rule out other possibilities.

First, barium swallow and endoscopy are used to check for structural issues. Endoscopy can exclude organic diseases such as esophageal cancer, submucosal tumors, reflux esophagitis, and eosinophilic esophagitis. Additionally, a barium swallow can be performed before endoscopy or as an initial test to rule out Zenker's diverticulum, achalasia, or extrinsic esophageal compression.

If these tests reveal no abnormalities, esophageal manometry is conducted. This involves inserting a pressure-sensing catheter into the stomach and gradually withdrawing it to measure pressure at different esophageal locations, checking for achalasia. If results remain normal, 24-hour pH monitoring is performed to exclude functional heartburn.

A balloon distension test may also be used to determine whether esophageal sensitivity is heightened or if sensory abnormalities exist.

TREATMENT

Which department should I see for functional dysphagia?

Gastroenterology, Dentistry, ENT (Ear, Nose, and Throat).

Is it necessary to visit a hospital for functional dysphagia?

Not always.

Some cases of dysphagia are temporary or do not significantly impact daily life, making a hospital visit unnecessary.

How is functional dysphagia treated?

• Adjust eating habits: chew thoroughly and avoid foods that are difficult to swallow.

• Smooth muscle relaxants or botulinum toxin injections may be effective. Balloon dilation therapy is also empirically used, though the exact mechanism remains unclear.

• Some reports suggest antidepressants may help, but clinical trial data is lacking.

Can functional dysphagia be cured?

The prognosis is generally good. Symptoms may improve spontaneously over time in some patients, and most see improvement or complete resolution after treatment.

DIET & LIFESTYLE

What should be paid attention to in daily life for functional dysphagia?

Change eating habits, chew slowly, and avoid foods that are difficult to swallow.

Does functional dysphagia affect fertility?

No.

Can people with functional dysphagia take flights, engage in strenuous exercise, or travel to high-altitude areas?

Yes.

PREVENTION

Can functional dysphagia be prevented? How to prevent it?

Since the cause of functional dysphagia is still unclear, it cannot be prevented.