title: Surgical treatment of primary esophageal motility disorders.
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.
authors.affiliation: Department of Surgery, Division of Esophagus and Stomach, Federal University of Sao Paulo, Rua Napoleao de Barros, 715 2nd floor, Sao Paulo, and Hospital Sao Paulo, Sao Paulo, 04024-002, Brazil. herbella.dcir@unifesp.epm.br
authors.forename: Fernando A
authors.initials: FA
authors.lastname: Herbella
authors.forename: Ana C
authors.initials: AC
authors.lastname: Tineli
authors.forename: Jorge L
authors.initials: JL
authors.lastname: Wilson
authors.forename: Jose C
authors.initials: JC
authors.lastname: Del Grande
mesh_terms: D015154:Esophageal Motility Disorders / Q000601:surgery*; D015155:Esophageal Spasm, Diffuse / Q000175:diagnosis / Q000601:surgery; D016629:Esophagectomy; D018662:Fundoplication; D006801:Humans; D008365:Manometry