Background. In untreated patients with a manometric pattern of either diffuse esophageal spasm (DES) or nutcracker esophagus (NE), the findings of a pH monitoring study are essential as the disease is considered a primary motility disorder (PEMD) only in the absence of reflux (GERD). If reflux is present, the motility abnormality is considered secondary and treatment is directed towards reflux. Aims. To determine in patient with a manometric picture of DES and NE: (a) if symptoms alone distinguish PEMD from GERD; and (b) the value of ambulatory pH monitoring. Patients and Methods. Ambulatory pH monitoring identified GERD in: (1) 124/180 patients (69%) with a manometric picture of NE: 31/56 patients (55%) with a primary disorder were thought to have GERD, and were taking proton pump inhibitors; (2) 73/121 patients (60%) patients with a manometric picture of DES: 39/48 patients (81%) with a primary disorder were thought to have GERD, and were taking proton pump inhibitors. Results: see table for results. Conclusions. These data show that: (a) 2/3 of patients with a manometric picture of NE or DES have GERD; and (b) symptoms did not allow to distinguish PEMD from GERD; and (c) 68% of patients with PEMD had been treated for GERD. Esophageal manometry and pH monitoring are essential to distinguish PEMD from GERD and to guide appropriate therapy.

* statistical significant (p<0.05)