Motility abnormalities of the esophageal body associated with gastroesophageal reflux disease (GERD) have been known for years. The descriptions of these abnormalities, however, have been nonspecific, and although attributed to GERD in general, the association with specific pathologic injury is unclear. Although classic teaching has dictated that therapy, specifically fundoplication, should be altered on the basis of these abnormalities, the literature calls this into question. This article sheds light on these issues and formulates specific statements and guidelines as to the clinical importance of esophageal body motility abnormalities associated with GERD.