Primary oesophageal motility disorders: how primary are they?

Normal oesophageal peristalsis is regulated by interacting nitric oxide-con taining inhibitory neurons and cholinergic excitatory nerve fibres, In achalasia, degenerative changes can be observed at various levels of neu ronal regulation of oesophageal motility. There is no evidence for neuronal degeneration in the pathogenesis of nutcr acker oesophagus. Achalasia and nutcracker oesophagus appear to be distinct oesophageal motor disorders with different aetiology. The normal regulation of oesophageal peristalsis is complex. Nitric oxide-c ontaining inhibitory neurons and cholinergic excitatory nerve fibres play t he key roles. In the so-called primary oesophageal motility disorders, the coordination of oesophageal contractions and lower oesophageal sphincter fu nction is disturbed (achalasia, diffuse oesophageal spasm), or the amplitud es of peristaltic contractions are abnormally high (nutcracker oesophagus). This article focuses on the pathophysiology of achalasia and nutcracker oe sophagus. There is evidence that achalasia and nutcracker oesophagus should not be considered parts of one and the same range of diseases. Eur J Gastr oenterol Hepatol 11:1345-1347 (C) 1999 Lippincott Williams & Wilkins.