Spectrum of Esophageal Motility Disorders

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Abstract
The named primary esophageal motility disorders (PEMDs), achalasia, diffuse esophageal spasm (DES), nutcracker esophagus (NE), and the hypertensive lower esophageal sphincter (HTN-LES)1 are characterized by esophageal dysmotility, which is responsible for the symptoms. The clinical presentation may be puzzling, especially when heartburn or chest pain are the presenting symptoms instead of dysphagia. Such patients may be treated for long periods with acid-suppressing medications on the wrong assumption that the diagnosis is gastroesophageal reflux disease (GERD).2 While a reasonable consensus has developed on the treatment of achalasia,3-7 this has not occurred for the other disorders. The goal of this study was to determine the role of esophageal function tests in diagnosing PEMD and the role of minimally invasive surgery in their treatment.