Diagnostic and treatment approaches associated with functional oesophageal disorders
This chapter reviews functional oesophageal disorders from a biopsychosocial perspective. It discusses the current research findings relating to the aetiology, physiology and diagnostic considerations and reviews the current psychological and medical interventions. Patients with upper gastrointestinal complaints account for a significant proportion of health-care utilization in adult populations throughout the United States. Gastroesophageal reflux disease (GERD) represents the most common upper gastrointestinal (GI) disorder in the outpatient setting with nearly 7 million visits for GERD-related symptoms in 2010. There is a high prevalence of GERD within patients with chest pain and heartburn; therefore high-dose proton pump inhibitor (PPI) therapy may be initially used to determine whether a diagnosis of GERD should be considered. Treatment for functional oesophageal disorders includes a holistic approach that incorporates the use of neuromodulation, pain modulation, medical therapy and psychological intervention. Psychological interventions are indicated for patients with no treatment response while on medication or who are interested in a non-pharmaceutical approach.