Pathophysiology and endoscopic/balloon treatment of esophageal motility disorders

Esophageal dysmotility syndromes encompass disease entities, such as diffuse esophageal spasm, nutcracker esophagus, hypertensive lower esophageal sphincter, nonspecific esophageal dysmotility dysfunction, and primary achalasia. The best understood of these remains achalasia. Traditional therapeutic modalities have included the use of pharmacologic agents, balloon dilatation, and surgery with varying degrees of success. The novel use of botulinum toxin has proven effective in patients with idiopathic achalasia, and the utility of this potent neurotoxin in nonachalasia esophageal motor disorders is currently being investigated. Conventional and newer therapies with a particular focus on endoscopic and balloon treatment of the various esophageal dysmotility disorders are discussed.