REFERENCE · DIAGNOSTIC TECHNIQUE

Globus and Oesophageal Diagnostic Criteria

Clinician-focused educational reference. Swallowing assessment requires appropriate training, consent and an individual safety plan. These are not home tests.

Purpose and Suitability
Anatomy and Physiology
Preparation and Safety
Performing the Assessment
Interpreting Findings
Explaining the Result
Evidence and Limitations
Media and Accessibility
Research and Sources

Purpose and Suitability

Distinguish a between-meals lump sensation from impaired food passage and apply the appropriate oesophageal criteria with medical assessment.

Oesophagus: The food pipe between throat and stomach. Odynophagia: Pain when swallowing.

This page concerns criteria and differential assessment, not a bedside manoeuvre that proves FND. A person may report several symptoms; each needs a formulation rather than forcing everything into one label.

Anatomy and Physiology

Food passage through the oesophagus depends on its lumen, lining and coordinated movement. A throat sensation alone does not identify which process is affected.

Motility: The movement that carries material along the gut. Disorder of gut–brain interaction: A diagnostic framework for symptoms involving gut function and its interaction with the nervous system.

The Rome oesophageal framework and a positive motor-FND examination are not equivalent diagnostic tools. Proposed mechanisms do not establish the cause in an individual. [3]

Preparation and Safety

Clarify whether the symptom is present between meals, during passage, or both; ask about pain, progression, weight change and previous investigations. Review reports before repeating tests. Explain why each proposed investigation could change care.

Do not wait for a duration criterion before investigating new dysphagia or alarm features. Do not prescribe medication, discontinue an intake plan or arrange a food challenge from this summary. These are clinical-use safeguards for an educational criteria guide.

Performing the Assessment

Current framework: Rome V

The following is an educational paraphrase, not the official questionnaire. Consult the linked source and specialist guidance for full definitions. [2]

Syndrome	Key criteria and boundaries
Globus	Non-painful lump sensation between meals, without dysphagia or painful swallowing; no explanatory structural lesion on examination/laryngoscopy, proximal gastric inlet patch, reflux/non-reflux inflammation or qualifying major motor disorder.
Functional dysphagia	Solid or liquid passage feels abnormal in the oesophagus, without an explanatory structural/mucosal, reflux/inflammatory or qualifying major motor disorder.
Timing	Both require weekly symptoms, criteria met for three months and onset at least six months earlier. The globus footnote additionally specifies at least eight weeks of optimized antisecretory therapy. This is a clinician-interpreted criterion, not advice to self-treat or delay investigation.

Rome V aligns reflux assessment with Lyon 2.0 and motor exclusions with Chicago v4.0; ineffective oesophageal motility is excepted from those motor exclusions. Specialist interpretation is necessary. [2]

Endoscopy, biopsy and oesophageal physiology

Selected endoscopy, mucosal sampling, manometry or reflux testing investigate plausible alternative explanations. These are differential tests. Findings and symptoms must be interpreted together; a series of normal results is not itself a positive functional sign. [1]

Record which differential question each investigation addresses and what remains untested. A gastroenterology plan may differ from a mouth-and-throat swallowing plan.

Interpreting Findings

Criteria supported: Name the syndrome and version, relevant positive symptom pattern and completed differential assessment. Do not silently translate “Rome-defined functional dysphagia” into “motor FND.”

Criteria not met: Dysphagia or painful swallowing prevents using the defined globus syndrome to account for that complaint; assess the actual difficulty. Symptoms may still require care before a duration threshold is reached.

Indeterminate: Incomplete investigations or an uncertain symptom pattern call for a qualified description and follow-up, not a diagnosis based solely on normal results.

A criteria diagnosis does not measure nutrition, meal duration, assistance or participation. Ask which needs remain even after the explanation is understood.

Explaining the Result

Authored example:

“The lump feeling and the problem of food passing are different questions. We are using the criteria that match your experience and checking the other causes that matter. I will explain which diagnosis is supported, what is still uncertain and what happens next.”

Keep distress and fear in the care discussion without using them as proof of a particular cause.

Evidence and Limitations

The inventory originally cited Aziz and colleagues’ 2016 Rome IV paper. It remains linked for provenance; the current criteria discussion uses the Foundation’s Rome V page and the 2026 oesophageal update. These are diagnostic frameworks, not accuracy estimates for an FND bedside test. [1][2][3]

The official Rome V criteria were checked directly. Full-text appraisal of the 2026 journal article was unavailable. Do not treat a normal investigation as evidence of voluntary control or use a criteria diagnosis to infer low disability.

Media and Accessibility

A simple labelled mouth–throat–oesophagus diagram can locate the questions without implying that a person’s felt location reliably identifies disease. A timeline may help explain duration criteria, provided it also states that alarm symptoms need prompt assessment. Use text equivalents and avoid colour-only distinctions. No media is supplied.

Research and Sources

Citation	Full citation
[1]	Aziz Q, Fass R, Gyawali CP, et al. Functional Esophageal Disorders. Gastroenterology. 2016;:S0016-5085(16)00178-5. DOI. PMID: 27144625. FND-CIT-0164.
[2]	Rome Foundation. Rome V Criteria. Sections A4 (Globus) and A5 (Functional Dysphagia). Current criteria. Accessed October 3, 2026. FND-CIT-0248.
[3]	Gyawali CP, Roman S, Zerbib F, Savarino EV, Bhatia S, Fass R, Pandolfino JE. Functional Esophageal Disorders. Gastroenterology. 2026;170(6):1224–1239. DOI. PMID: 42031441. FND-CIT-0249.