Symptoms such as chest pain, dysphagia, nausea and vomiting, loss of appetite, and aspiration into trachea are frequently encountered in clinical practice. It is essential to consider esophageal functional abnormalities in the differential diagnosis. We have proposed diagnostic algorithm for esophageal motility disordersEsophageal motility disorders using upper gastrointestinal video fluoroscopy and esophageal manometryEsophageal manometry. Following of exclusion diagnosis of organic lesions, GERD or FGIDs, psychological disorders, we actively diagnose esophageal motility disordersEsophageal motility disorders and treat patient with medication or psychosomatic intervention. Case 1 is a 39-year-old male with non-cardiac chet pain. He was diagnosed hypercontractile esophagus with esophageal manometryEsophageal manometry. He was treated medications of calcium channel blockers and nitroglycerin; symptoms subsequent improved. Case 2 is an 80-year-old male with Parkinson’s disease, dysphagia, and loss of appetite. He was diagnosed achalasiaAchalasia (type III) with upper GI video fluoroscopyUpper GI video fluoroscopy and esophageal manometry. Although initial treatment with medications led to improvement, the condition relapsed due to stress related to a natural disaster. Psychosomatic interventionPsychosomatic intervention contributed to subsequent recovery. Video fluoroscopy is a valuable screening tool that can be performed at any facility equipped with radiographic equipment. When abnormalities are detected, referral to a facility equipped with esophageal manometryEsophageal manometry is recommended to facilitate appropriate treatment. Broader adoption of this diagnostic approach in general clinical practice is strongly encouraged.