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Surgical Treatment of Primary Esophageal Motility Disorders

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Journal of Gastrointestinal Surgery

Abstract

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.

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Acknowledgements

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

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Authors and Affiliations

  1. Department of Surgery, Division of Esophagus and Stomach, Federal University of Sao Paulo, Rua Napoleao de Barros, 715 2nd floor, Sao Paulo, Sao Paulo, 04024-002, Brazil

    Fernando A. Herbella, Ana C. Tineli, Jorge L. Wilson Jr. & Jose C. Del Grande

  2. Surgical Gastroenterology, Division of Esophagus and Stomach, Hospital Sao Paulo, Rua Napoleao de Barros, 715 2nd floor, Sao Paulo, Sao Paulo, 04024-002, Brazil

    Fernando A. Herbella

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  1. Fernando A. Herbella
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Correspondence to Fernando A. Herbella.

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Herbella, F.A., Tineli, A.C., Wilson, J.L. et al. Surgical Treatment of Primary Esophageal Motility Disorders. J Gastrointest Surg 12, 604–608 (2008). https://doi.org/10.1007/s11605-007-0379-5

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  • DOI: https://doi.org/10.1007/s11605-007-0379-5

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