Psychophysiological interactions in esophageal diseases.

The biopsychosocial dimensions of esophageal diseases are recently being recognized. Globus sensation is not associated with augmented or spastic upper esophageal sphincter function, but patients do have a high level of somatic concern, anxiety, or depression. Spastic esophageal motility disorders are frequently triggered by both physiological and psychological stressors. In susceptible patients, anxiety increases the report of reflux symptoms, but not the actual amount of acid reflux, whereas relaxation therapy decreases both reflux symptoms and total acid exposure time. Patients with chest pain of unknown cause have increased somatic concern about heart disease, anxiety, depression, and esophageal specific visceral hypersensitivity to balloon distention. Psychotropic drug therapy to increase pain thresholds and modulate psychiatric disease and behavioral therapies are appropriate in selected patients with esophageal diseases.