Esophageal dysmotility disorders encompass a variety of conditions affecting peristalsis and/or emptying through the gastroesophageal junction (GEJ). Dysmotility disorders include achalasia, distal esophageal spasm, and nutcracker esophagus. Achalasia is a condition in which the GEJ is unable to relax to allow a food bolus to pass through. Patients will typically present with dysphagia. Dysphagia should be categorized into oropharyngeal dysphagia, intrinsic motor esophageal dysphagia, and dysphagia from a fixed obstruction. A careful history and physical exam should help delineate these different categories. Patients with oropharyngeal dysphagia will typically describe experiencing symptoms at the neck when initiating a swallow. Patients with esophageal dysphagia will describe a sticking sensation as food passes to the stomach seconds after a food bolus is swallowed. Dysphagia to liquids versus solids can help identify an obstructing lesion. Achalasia is generally diagnosed between ages 25 and 60 and is uncommon, with an incidence of 1.6/100,000. Males and females are affected equally. Achalasia is defined as integrated relaxation pressure (IRP) >15 mmHg and absent or impaired peristalsis on high resolution manometry (HRM), “birds beak” appearance on barium swallow, or resting LES pressure >35 mmHg. The Eckhardt scoring system provides 0–3 points for dysphagia, regurgitation, chest pain, and weight loss. Eckhardt scores greater than or equal to 3 are suggestive of the diagnosis. Achalasia is postulated to result from degeneration of neurons in the esophageal wall. Histology typically shows decreased neurons (ganglion cells) in the myenteric plexus. Preferentially involves the nitric oxide (NO) producing inhibitory neurons that affect sphincter relaxation. Buzz words: “Birds beak” appearance; Myenteric plexus; Loss of inhibitory neurons