Swallowing is a complex mechanism based on the coordinated collaboration of tongue, pharynx and oesophagus. Disturbances of this interplay or disorders of one or several of these components lead to dysphagia, non-cardiac chest pain or regurgitation. The major oesophageal motility disorders – achalasia, diffuse oesophageal spasm, hypercontractile oesophagus (“nutcracker oesophagus“) and non-specific motility disorder – are of unknown aetiology. Gastroesophageal reflux disease (GERD) might also be caused by a primary oesophageal motility disorder. Despite the beneficial effect of the various drugs on oesophageal motility parameters, the clinical benefit of medical treatment of oesophageal motility disorders is rather disappointing (with the exception of medical therapy of GERD and pneumatic dilation and botulinum toxin for achalasia). From clinical studies, there is some evidence of a psychological component in the pathogenesis or perception of oesophageal symptoms. Patients benefit from centrally acting drugs.