Functional Esophageal Disorders.

Functional esophageal disorders manifest a complex interplay between subtle physiomechanical perturbations and altered peripheral and central neuropsychological processing. These disorders present with heartburn, chest pain, globus and/or dysphagia, in the absence of structural abnormalities, esophageal motility disorders, or overt gastroesophageal reflux disease. Visceral hypersensitivity from peripheral or central neural dysfunction is thought to contribute significantly to symptom generation, potentially triggered by low-grade inflammation or compensatory responses to repetitive noxious stimuli. Hypervigilance impairs interpretation and regulation of internal sensory signals, modulated by cognitive and affective processes and by psychosocial stressors. Therapeutic approaches targeting minimal motor abnormalities or further reducing physiologic reflux have limited benefit. In contrast, modulation of peripheral sensory inputs and central perception pathways are conceptually and clinically promising, although outcome data remain sparse. Future research should prioritize elucidating the neurobiological mechanisms underlying esophageal hypersensitivity and hypervigilance to inform the development of targeted and effective treatments.