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Introduction: Manometric pattern of either diffuse esophageal spasm (DES), nutcracker esophagus (NE), or hypertensive lower esophageal sphincter (HLES) can be considered a primary esophageal motility disorder only in the absence of gastroesophageal reflux disease (GERD). If GERD is present, the motility abnormality is considered secondary, and treatment is directed toward reflux. This study aims to evaluate the outcomes of laparoscopic Nissen fundoplication (LNF) in patients with manometric patterns of esophageal motility disorders.
Methods: Patients with GERD confirmed by pHmonitoring and manometric pattern of DES (simultaneous contractions 20-90% of wet swallows), NE (increased mean distal amplitude greater than 180mmHg), or HLES (lower esophageal sphincter pressure greater than 45mmHg) that underwent LNF were studied. A group of 50 consecutive patients with normal esophageal motility that underwent LNF were used as controls. Groups were comparable to controls for age, gender, pre-operative symptoms, hiatal hernia and barrett s esophagus, except for NE that had younger individuals (table 1).
Results: Symptomatic outcome was similar when groups were compared to controls (table 2).
Conclusion: LNF is an adequate treatment for patients with GERD and manometric patterns of esophageal motility disorders.

Table 1. Preoperative data.

	n	age (years)	% females	dysphagia	esophageal symptoms	extra-esophageal symptoms	% Barrett's esophagus	% hiatal hernia
hypertensive LES	3	57	66	66	100	0	0	66
diffuse spasm	14	52	50	15	86	29	29	86
nutcracker	13	46	61	15	100	23	8	69
controls	50	57	64	14	84	28	10	88

Table 2. postoperative data.

	follow-up (months)	dysphagia	esophageal symptoms	extra-esophageal symptoms
hypertensive LES	21	33	0	0
diffuse spasm	32	7	7	7
nutcracker	25	0	8	8
controls	36	20	18	2