Overview of Dysphagia
Functional dysphagia refers to the “obstruction” of food transportation from the oral cavity to the stomach and cardia, resulting in a “sense of obstruction and stagnation” or a “sense of foreign body” in the pharynx, retrosternum, or esophagus, and a “sensation of foreign body” in the esophagus. Barium esophageal X-ray examination, endoscopy and esophageal manometry can rule out pathologic gastroesophageal reflux, esophageal cancer, mucosal ring and other diseases. The main clinical manifestation is repeated episodes of dysphagia, and this disease is one of the least frequent functional esophageal diseases.
Etiology
This disease may be associated with abnormal esophageal motility and sensory abnormalities. Psychological factors may also affect the motor function of the esophagus. In addition, anxiety, depression, and somatizing psychiatric disorders may also influence the development of the disease.
Symptoms
Clinical manifestations include solid or liquid adherence to the esophagus or a foreign body sensation when food passes through the esophagus. Dysphagia recurs for at least 6 months.
Examination
1. endoscopy: can exclude dysphagia due to organic esophageal pathology.
2. 24h esophageal pH monitoring: to exclude the presence of pathologic reflux or, although there is no pathologic reflux, to determine the relationship between dysphagia and acid reflux, and to help identify some of the patients in whom anti-reflux therapy is potentially effective.
3. 24h esophageal manometry to rule out esophageal dyskinetic disorders such as diffuse esophageal spasm.
Diagnosis
The diagnosis is aided by the history and relevant clinical examination.
Differential diagnosis
1. Intraesophageal lesions
Including esophageal mucosal injury caused by food and other factors, esophageal tumor, esophageal Crohn’s disease, fungal esophagitis, etc. Dysphagia may occur, which can be clearly diagnosed by gastroscopy.
2.Diseases of esophageal power disorder
Dysphagia can be caused by cardia dystrophy, diffuse esophageal spasm, nutcracker esophagus, etc. Pressure measurement of the esophagus is helpful in the diagnosis of the above diseases.
Treatment
The treatment of functional dysphagia includes medication and psychological aspects.
1. Psychotherapy
Psychotherapy plays an important role in the treatment of this disease, including avoiding stimuli that aggravate the disease, eliminating worries and providing necessary psychological counseling.
2. Drug therapy
(1) Small doses of anti-anxiety and antidepressant drugs are tried.
(2) Anti-reflux treatment: proton pump inhibitors or H2 receptor antagonists can be used.
3. Endoscopic treatment
Dilatation therapy is feasible for those with delayed emptying of the distal esophagus and incomplete relaxation of the lower esophageal sphincter.