Journal of Gastrointestinal Surgery

, Volume 12, Issue 3, pp 604–608 | Cite as

Surgical Treatment of Primary Esophageal Motility Disorders

  • Fernando A. HerbellaEmail author
  • Ana C. Tineli
  • Jorge L. WilsonJr.
  • Jose C. Del Grande


Named primary esophageal motility disorders (PEMD) present with specific manometric patterns classified as: (1) hypertensive lower esophageal sphincter, (2) nutcracker esophagus (also hypercontratile, hypertensive, or hypercontracting esophagus), (3) diffuse esophageal spasm, and (4) achalasia. These conditions, with the exception of achalasia, are rare, poorly understood, and inadequately studied. Treatment of these conditions is based on symptoms and aimed at symptomatic improvement. The authors reviewed current literature on surgical treatment of non-achalasia PEMD. The review shows that: (a) surgical therapy may be an attractive alternative in patients with PEMD; (b) proper selection of patients based on symptoms evaluation and esophageal function tests is essential; (c) laparoscopic myotomy with proximal extent tailored to manometric findings seems to be the ideal surgical therapy; and (d) esophagectomy may be necessary as a last resource due to multiple failures of surgical conservative treatment.


Esophageal motility disorders Hypertensive lower esophageal sphincter Esophageal spasm Nutcracker esophagus Surgery Myotomy Esophagectomy 



Figure 1 is a courtesy of Thomas J. Watson, MD.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Fernando A. Herbella
    • 1
    • 2
    Email author
  • Ana C. Tineli
    • 1
  • Jorge L. WilsonJr.
    • 1
  • Jose C. Del Grande
    • 1
  1. 1.Department of Surgery, Division of Esophagus and StomachFederal University of Sao PauloSao PauloBrazil
  2. 2.Surgical Gastroenterology, Division of Esophagus and StomachHospital Sao PauloSao PauloBrazil

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