Esophageal motility disorders often present with chest pain and dysphagia. Achalasia is a disorder of the lower esophageal sphincter and the smooth muscle fibers of the esophagus. In achalasia, the lower esophageal sphincter usually does not relax with swallowing and the esophagus is not peristaltic. In contrast to spastic disorders of the esophagus, achalasia can be progressive and cause severe morbidity.
Esophageal spastic disorders, such as diffuse esophageal spasm (DOS) and oesophageal sphincter (OK) are benign and non-progressive, with similar findings in esophageal manometry. Although the exact cause remains unknown, these disorders may represent a manifestation of gastroesophageal reflux disease.
Dysphagia and chest pain are common symptoms in general medical practice. When episodes of chest pain are accompanied by dysphagia and cardiac sources of pain are officially ruled out, the esophagus often becomes the main focus of research. Gastroesophageal reflux disease (GERD) can sometimes be implicated as the cause of such symptoms, but spastic disorders of the esophagus or lower esophageal sphincter (LES) should be included in the differential diagnosis.