Functional Dysphagia

  • Ofer Z. Fass
  • Ronnie Fass


Functional dysphagia is an uncommon cause of dysphagia symptoms presenting a diagnostic and therapeutic challenge to clinicians. It is defined as a sensation of abnormal bolus transit in the absence of any mucosal, structural, or major functional abnormalities of the esophagus. The pathophysiology of functional dysphagia is multifactorial and includes esophageal hypersensitivity, abnormal central processing of esophageal stimuli, intermittent abnormal esophageal motor disorder, and psychological comorbidities. Diagnosis requires exclusion of structural, mucosal, and major esophageal motor disorders. This is accomplished with a careful history and physical examination, upper endoscopy with mucosal biopsies, and high-resolution esophageal manometry. Treatment of functional dysphagia includes lifestyle modifications and avoidance of triggers, neuromodulators, and management of psychological comorbidities. Nonpharmacologic management includes bougie dilation and in carefully selected patients botulinum toxin injections into the distal esophagus. Functional dysphagia remains an area of active research, and thus, the definition, epidemiology, diagnosis, and treatment are likely to continue and evolve in the future.


Dysphagia Neuromodulator Hypersensitivity Esophagus Esophageal motility Proton pump inhibitor 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Ofer Z. Fass
    • 1
  • Ronnie Fass
    • 2
  1. 1.Department of MedicineNew York University Langone Health, New York UniversityNew YorkUSA
  2. 2.Case Western Reserve University, Digestive Health Center, Division of Gastroenterology and Hepatology, MetroHealth Medical CenterClevelandUSA

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