ESOPHAGEAL MOTOR DISORDERS

The past 12 months have yielded several interesting developments in ou r understanding of normal esophageal physiology and esophageal motor d isorders and their management. Further insights into the control of sw allowing and esophageal peristalsis have come from the use of transcra nial electromagnetic stimulation, investigation of pharyngeal sensatio n, and studies into the roles of inhibitory neurotransmitters and calc ium. The activity of the longitudinal muscle is assuming increasing im portance in esophageal peristalsis and esophageal transport. Achalasia continues to attract considerable interest with a further report of a ntineuronal antibodies and investigations of esophageal tone, inhibito ry innervation, and gastroesophageal reflux. There is continued intere st in the use of botulinum toxin, not only for the treatment of achala sia, but also for the treatment of other motor disorders such as esoph ageal muscular rings and esophageal diverticula. Several studies have assessed laparoscopic myotomy for the treatment of achalasia. Ambulato ry manometry has been evaluated for the diagnosis of diffuse esophagea l spasm.