Key Points

• Esophageal motility disorders may be due to intrinsic disorders of the esophagus or secondary due to systemic disease
• High resolution manometry is the main diagnostic study used to differentiate between the various types of motility disorders
• Medical, surgical or endoscopic treatment modalities exist with a variety of success for individual motility disorders. Novel endoscopic therapies include POEM, POPE, and POET.

Symptoms of esophageal motility disorders include atypcial or noncardiac chest pain, dysphagia and regurgitation. Esophageal motility disorder evaluation begins with history, clinical examination, and radiographic studies. High resolution manometry assesses the effectiveness of lower esophageal sphincter pressure and relaxation and the character of peristaltic waves. Motility disorders can be classified into primary esophageal motility disorders (PEMD), which are non-related to systemic disease or secondary disorders if they are associated with other systemic disease (Table 1). Primary disorders are less common, as one study noted an incidence of only 11.4% of 3,471 patients who were referred for evaluation[1]. The most common primary motility disorders include achalasia, diffuse esophageal spasm (DES), hypercontractile esophagus, hypertensive lower esophageal sphincter (HLES), and ineffective esophageal motility (IEM) which are summarized in Table 2. In this chapter, we discuss each of these conditions including clinical presentation, diagnosis, and treatment.