Ravich W J, Wilson R S, Jones B, Donner M W
Dysphagia. 1989;4(1):35-8. doi: 10.1007/BF02407400.
Despite warnings against attributing dysphagia to psychological causes, the diagnoses of "psychogenic dysphagia" or "globus hystericus" have been previously applied to 13% of patients referred to the Johns Hopkins Swallowing Center. This paper reports the results of reevaluation of 23 patients previously diagnosed as having symptoms of psychogenic origin. The Swallowing Center evaluation documented an explanation for symptoms in 15 (65%). No cause of dysphagia could be documented in eight patients. All five patients with the "globus sensation" had a documentable abnormality of swallowing. Overall, nine patients had esophageal pathology, while six had pharyngeal disease. Five had structural lesions constricting the lumen, while 10 had motor dysfunction of either the pharynx or esophagus. Review of the referral records of these patients indicates the quality of prior evaluation for patients previously labeled as having a swallowing disorder of psychogenic origin is variable, and that once attribution of symptoms to psychogenic causes is made, the diagnosis is rarely reconsidered. We conclude that attribution of the diagnosis of psychogenic dysphagia should be made with caution, and only after thorough evaluation. Any change or progression of symptoms should prompt a careful re-evaluation.
尽管有警告称不要将吞咽困难归因于心理原因，但“精神性吞咽困难”或“癔球症”的诊断此前已应用于转诊至约翰霍普金斯吞咽中心的13%的患者。本文报告了对23例先前被诊断为有精神源性症状患者进行重新评估的结果。吞咽中心的评估为15例（65%）患者的症状找到了原因。8例患者未发现吞咽困难的病因。所有5例有“癔球感”的患者都有可记录的吞咽异常。总体而言，9例患者有食管病变，6例有咽部疾病。5例有管腔狭窄的结构性病变，10例有咽部或食管的运动功能障碍。对这些患者转诊记录的回顾表明，先前被标记为有精神源性吞咽障碍患者的先前评估质量参差不齐，而且一旦将症状归因于精神原因，很少会重新考虑诊断。我们得出结论，精神性吞咽困难的诊断应谨慎做出，且仅在全面评估之后。症状的任何变化或进展都应促使进行仔细的重新评估。
