Traumatically acquired conditioned dysphagia in children.

A new diagnosis identifying a nonorganic basis of dysphagia is proposed in relation to behavioral conditioning processes and thereby labeled "conditioned dysphagia" (CD). Literature review of both animal and human studies documents that rapidly acquired and persistent avoidance responses are learned when autonomic functions are contiguous with traumatic physical events. Three case studies with primary diagnoses of TE fistula, congenital heart disease and pseudobulbar palsy demonstrated an association between CD and early childhood incidence of trauma involving the esophagus. Successful treatment was achieved by operant deconditioning therapy. Results of a pilot epidemiological study of 28 postpharyngeal flap surgery children and 47 controls showed significantly higher incidence of mild to moderate CD in the surgery group.