Gastroesophageal reflux disease and esophageal motility disorders

Gastroesophageal reflux disease is a common disorder with a seemingly increasing incidence in the Western countries. Profound acid inhibition therapy has occupied a central role in the medical management of reflux disease both in the short- and long-term perspective. The indications for long-term medical management are fairly similar to that for antireflux surgery. Today the laparoscopic approach to antireflux surgery is totally dominating with promising short-term clinical results. Relapses and failures usually occur early after << conventional-open >> antireflux surgery, so it is assumed that the long-term outcome also after laparoscopic antireflux procedures can be expected to be favourable. The motor disorder of the esophagus and gastroesophageal junction which engages the surgeons is primarily achalasia. Achalasia is manometrically characterised by a lack of coordinated peristaltic motor function in the body of the esophagus and a high tone of the lower esophageal sphincter with an incomplete lack of relaxation on swallowing. More seldomly diffuse spasm and nut-crackers esophagus is diagnosed. The laparoscopic-thoracoscopic approaches to these conditions are now quite dominating as the surgical therapeutic option.