Functional Swallowing Symptoms and Globus: Diagnostic Technique Inventory

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Criteria update — October 3, 2026: The inherited Rome entries below cite the 2016 Rome IV paper for provenance. Use the current Rome V discussion for present assessment; the original descriptions are not a complete current criteria checklist.

Clinical assessment · FEES/VFSS · Globus and oesophageal criteria

Diagnostic techniques at a glance

Clinical swallowing assessment

The clinician distinguishes mouth/throat swallowing difficulty from oesophageal symptoms and reviews safety, nutrition and examination findings. A specific task inconsistency can contribute to a formulation, but a normal bedside examination cannot exclude aspiration or other swallowing disease. [1][2]

Cross-task swallowing comparison

Swallowing behaviour is compared across clinically appropriate contexts, including spontaneous and requested actions. A reproducible mismatch may be informative. Different textures or volumes are only used within an assessed safety plan; variability is not a standalone FND sign. [1]

FEES

A flexible endoscope evaluates pharyngeal swallowing and airway protection. Findings can identify impairment or preserved function for tested conditions. This is a differential and safety investigation, not an independent positive test for functional dysphagia. [1][2]

Videofluoroscopic swallowing study

Moving X-ray images assess bolus movement and aspiration during selected swallows. The study can identify structural or physiological problems and guide safe interpretation of symptoms. Normal sampled swallows do not automatically establish a functional diagnosis. [1][2]

Rome criteria for functional dysphagia

Formal oesophageal criteria require a characteristic sticking or passage complaint and evaluation for structural, mucosal, reflux-related and major motility causes. These are consensus criteria for an oesophageal disorder, not simply a positive motor-FND sign. [3]

Rome criteria for globus

Globus describes a non-painful lump or foreign-body sensation, usually between meals, without dysphagia or painful swallowing in the defined syndrome. Required duration and differential assessment matter; a persistent lump sensation is not automatically FND. [3]

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. [3]

Research and Sources

Original source associations are preserved. The 2016 criteria source is historical; the linked detailed page supplies the current criteria and evidence limits.

Citation	Full citation
[1]	Baker J, Barnett C, Cavalli L, et al. Management of functional communication, swallowing, cough and related disorders: consensus recommendations for speech and language therapy. Journal of Neurology, Neurosurgery & Psychiatry. 2021;92(10):1112–1125. FND-CIT-0025. https://doi.org/10.1136/jnnp-2021-326767
[2]	American Speech-Language-Hearing Association. Adult Dysphagia. Practice Portal. Source. Accessed September 19, 2026. FND-CIT-0115.
[3]	Aziz Q, Fass R, Gyawali CP, et al. Functional Esophageal Disorders. Gastroenterology. 2016;:S0016-5085(16)00178-5. DOI. PMID: 27144625. FND-CIT-0164.