Primary E disorder.pdf

Surgical Treatment of Primary Esophageal Motility Disorders Fernando A. Herbella Ana C. Tineli Jorge L. Wilson Jr. Jose C. Del Grande Received: 16 August 2007 /Accepted: 26 September 2007 /Published online: 13 November 2007 # 2007 The Society for Surgery of the Alimentary Tract 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 hyper- contracting 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. Keywords Esophageal motility disorders . Hypertensive lower esophageal sphincter . Esophageal spasm . Nutcracker esophagus . Surgery .Myotomy . Esophagectomy Introduction Most esophageal motility abnormalities are secondary to gastroesophageal reflux disease (GERD).1,2 Named primary esophageal motility disorders (PEMD) occur in the absence of GERD and present with specific manometric patterns classified as: (1) hypertensive lower esophageal sphincter (HLES), (2) nutcracker esophagus (NE; also hypercontra- tile, hypertensive, or hypercontracting esophagus), (3) diffuse esophageal spasm (DES), and (4) achalasia.3 These conditions, with the exception of achalasia, are rare, poorly u