Nowadays primary esophageal motor disorder (PEMD) is considered to be a single disease, based on the, sometimes hypertonic, lower esophageal sphincter barrier, which may have its relaxation abilities altered. The struggle of the esophageal body to overcome that barrier results in different patterns of progression in the PEMD, from high amplitude contractions (symptomatic esophageal peristalsis or nutcracker esophagus), in other situations or patients, the deterioration of the musculature of the esophageal body generating simultaneous contractions (idiopathic diffuse esophageal spasm, IDES), to the final stage in this process, the absolute aperistalsis (achalasia) when the esophageal body motility eventually fails and its ability to cause peristaltic waves stops. This pathophysiological view would explain the cases of EDEI described that progress to achalasia. The progression always evolves from less advanced forms to more advanced ones. The review includes all diagnostic and therapeutic aspects of various PEMD.