Multidisciplinary Assessment and Management of Functional Dysphagia 2025 Blonski et al

Andy

Andy

Senior Member (Voting rights)

Abstract​

Functional dysphagia (FD), a type of functional esophageal disorder, is characterized by difficulty passing solid and/or liquid food through the esophagus, without underlying mucosal, luminal, or major motility diseases, as defined by the Rome IV criteria. It is also a type of functional gastrointestinal disorder (FGID), which are disorders of gut-brain interaction (DGBI). The underlying mechanism is thought to involve a complex interaction between the gut and central nervous system (CNS), where altered gut signaling may lead to visceral hypersensitivity, while CNS dysregulation may cause hyper-vigilance, potentially contributing to motor disturbances.

There is no standardized approach to the evaluation of FD and historically, it has been considered a diagnosis of exclusion. There is also no standardized treatment algorithm, and most FD treatments are garnered from other FGIDs. As our field gains a deeper appreciation of FGIDs, it is also clear that the management of suspected FD patients requires a multidisciplinary approach.

This narrative review not only 1) provides an overview of FD including its definition, epidemiology, pathophysiology, clinical characteristics, associated disorders, multidisciplinary assessment, and treatment, but also 2) details our unique multidisciplinary approach to FD patients from the perspective of gastroenterologists, speech-language pathologists (SLPs), and GI psychologists at the Joy McCann Culverhouse Center for Swallowing Disorders at the University of South Florida (USF CSD).

Open access
 
"Other Associated Disorders

The condition of FD is frequently observed alongside other DGBIs or extraintestinal functional disorders such as fibromyalgia, chronic fatigue syndrome, and chronic cystitis.41 The presence of another DGBI or FND should heighten clinical suspicion for FD, as the diagnosis of one functional disorder can increase the likelihood of another. It also emphasizes its complex, interconnected nature. In fact, when patients present with multiple DGBIs, or a combination of DGBIs and other functional somatic conditions, it can exacerbate disease severity and diminish QoL. This raises the critical question of whether these different DGBIs are separate conditions or represent various manifestations of a shared underlying pathophysiology.

Building on this understanding, we believe that we should also consider two additional disorders in the context of FD: Avoidant/Restrictive Food Intake Disorder (ARFID) and Muscle Tension Dysphagia (MTDg). Both conditions have unique symptoms and diagnostic criteria and evaluating them within the framework of FD is important to make an accurate diagnosis and to guide effective treatment."
 
Andy said:
Functional dysphagia (FD), a type of functional esophageal disorder, is characterized by difficulty passing solid and/or liquid food through the esophagus
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Interesting they have chosen to restrict themselves to the oesophagus. Does that mean those with broader issues or problems further along the digestive tract escape from the functional conditions crew’s empire building?

As always one worries how many treatable conditions get missed because of such a diagnosis. Also what evidence is there for a whole team of professionals having no idea about what they are doing is any better than just one?
 
Andy said:

Abstract​

Functional dysphagia (FD), a type of functional esophageal disorder, is characterized by difficulty passing solid and/or liquid food through the esophagus, without underlying mucosal, luminal, or major motility diseases, as defined by the Rome IV criteria. It is also a type of functional gastrointestinal disorder (FGID), which are disorders of gut-brain interaction (DGBI). The underlying mechanism is thought to involve a complex interaction between the gut and central nervous system (CNS), where altered gut signaling may lead to visceral hypersensitivity, while CNS dysregulation may cause hyper-vigilance, potentially contributing to motor disturbances.

There is no standardized approach to the evaluation of FD and historically, it has been considered a diagnosis of exclusion. There is also no standardized treatment algorithm, and most FD treatments are garnered from other FGIDs. As our field gains a deeper appreciation of FGIDs, it is also clear that the management of suspected FD patients requires a multidisciplinary approach.

This narrative review not only 1) provides an overview of FD including its definition, epidemiology, pathophysiology, clinical characteristics, associated disorders, multidisciplinary assessment, and treatment, but also 2) details our unique multidisciplinary approach to FD patients from the perspective of gastroenterologists, speech-language pathologists (SLPs), and GI psychologists at the Joy McCann Culverhouse Center for Swallowing Disorders at the University of South Florida (USF CSD).

Open access
Click to expand...
Do these people ever have to provide proper long-term outcome data for their new 'treatment proposals' for what from the next post sounds like is an attempt to categorise a lot of things into as a bucket.

Surely if everyone with x who they send to y 'because its functional' and insist on 'treating with robust psych instead of z' then doesn't end up dead from not getting z in 5, 10yrs time? And the 'mental health label' certainly shouldn't then be an excuse for 'death being an OK outcome' when/if z treatment, without the mental health label or insinuation, doesn't result in death - but was in fact the same condition pre-rebrand. Wouldn't that make it the worst new treatment programme possible if it merely worsened outcomes or mortality?

And wouldn't saying that just because you've now added a mental health label makes that worse outcome somehow either acceptable or not the problem of these departments who shipped said individuals off to a different department in order that they didn't get 'z' be more than mental health stigma but weaponisation of it to muddy the waters on said mortality figures?

SO where is the honed-in on look at the most important outcomes: mortality and health at 5yrs and 10yrs, probably 20 and 30yrs given what huge a population of other illnesses they are trying to suggest 'indicate deserve the person throwing into the bucket without investigation regarding any future gastro issues ... if we label one of their current conditions as 'functional' so it somehow generalises to not dealing with anything else they have'?

And why is anyone suggesting removing what can be life-sustaining or life-saving treatment from populations without being required to demonstrate that the alternative at least keeps them alive...

screw the theory on what someone thought of their experience whilst they died, isn't it required that be the focus to actually put real figures on it without excuses justifying if it turns out to be worse?

And if they aren't talking about these things then these can't be serious people who take whether people survive seriously? So shouldn't be taken seriously themselves therefore surely by a profession that understand that ie outcomes as the important thing.

Otherwise, you know, your theory is neither real nor even taken seriously by yourself if you avoid that acid test - it is just the equivalent of fiddling while Rome burns and moving somewhere to something where they die instead of not dying whilst you discuss how you consider 'that type doesn't think properly' over their beds? Which is hardly laudable as what I thought medicine was or most should?
 
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Since when is chronic cystitis also a functional disorder?

I still don't have any idea of what a functional disorder is supposed to be. If a functional disorder is something that effects the function of the body, wouldn't almost any disease be functional?
 
Andy said:
"Other Associated Disorders

The condition of FD is frequently observed alongside other DGBIs or extraintestinal functional disorders such as fibromyalgia, chronic fatigue syndrome, and chronic cystitis.41 The presence of another DGBI or FND should heighten clinical suspicion for FD, as the diagnosis of one functional disorder can increase the likelihood of another. It also emphasizes its complex, interconnected nature. In fact, when patients present with multiple DGBIs, or a combination of DGBIs and other functional somatic conditions, it can exacerbate disease severity and diminish QoL. This raises the critical question of whether these different DGBIs are separate conditions or represent various manifestations of a shared underlying pathophysiology.

Building on this understanding, we believe that we should also consider two additional disorders in the context of FD: Avoidant/Restrictive Food Intake Disorder (ARFID) and Muscle Tension Dysphagia (MTDg). Both conditions have unique symptoms and diagnostic criteria and evaluating them within the framework of FD is important to make an accurate diagnosis and to guide effective treatment."
Click to expand...


"two additional disorders in the context of FD: Avoidant/Restrictive Food Intake Disorder (ARFID) and Muscle Tension Dysphagia (MTDg). "

For those with Severe ME / CFS this is disturbing .
There will be many more Maeves .
 
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