**7. Diagnosis of functional swalloving disorders**

Conventional radiology, computed tomography, ultrasound scans, and magnetic resonance imaging facilitate visualization of gastrointestinal tract organ morphology, but these scans cannot precisely quantify their function. In the diagnosis of esophagus disease, fluoroscopy has been used with non-physiological contrast materials, and this is not a quantitative evaluation either. The use of endoscopy or manometry is an invasive way of investigating the organ condition. The use of nuclear medicine can quantify gastrointestinal organ function assessment by measuring the passage of isotope-labeled material (Russel et al., 1981). At the investigation of patients with dysphagia and normal manometric and endoscopic findings, 50% of them presented dysmotility when dynamic scintigraphy was used (Kjellen et al., 1984). A positive diagnoses of functional gastrointestinal disorders are a result of an expert gastroenterologist´s work. Usually, this diagnosis is determined after exclusion of all other potential causes of dysfunction.

However, it is necessary to take into account the importance of psychological factors that may be the cause of motility disorders of the esophagus. Studies using sophisticated psychometric instruments, dealing with the importance of psychological factors in patients with painful esophageal motility disorders, identified a number of mutual relations. Groups of patients with esophageal spasm, with irritable colon, with benign abnormalities of the impaired esophagus were compared with a control set of healthy persons. Patients with esophageal motility and irritable colon had significantly higher scores than other groups with somatic anxiety and gastrointestinal susceptibility. This shows that certain patients tend to have a significant interest in the somatic function and have more frequent and severe gastrointestinal symptoms due to stress (Waterman et al., 1989).

When 50 referred patients with pathogenic esophageal manometry underwent a psychiatric examination, abnormalities were detected in 21 out of 25 patients with motility disorders of the distal esophagus. On the contrary, abnormalities were found in only 4 out of 13 patients with normal manometric findings. The most common findings were somatization disorders, anxiety, and depression. (Clouse & Lustman, 1983).
