 We will evaluate the effect of topically applied bethanechol on esophageal motility in a cohort n20 of patients with IEM. Presence of IEM will be defined using current criteria: esophageal contraction amplitude 30 mmHg either 5 or 10 cm above the lower esophageal sphincter, in 50 or more of saline swallows15, 16. We will perform high-resolution manometry HRM to establish a baseline in these patients. HRM is part of the cutting-edge technology available at the Medical College of Georgia Center for Voice and Swallowing Disorders CVSD, part of the Department of Otolaryngology, and is used in the clinical evaluation of patients with dysphagia on a routine basis. Many patients with IEM referred to the CVSD will undergo high-resolution manometry during the course of their evaluation and treatment, regardless of inclusion in this study. The test consists of placement of a manometry catheter through the nasal cavity into the esophagus, much as a naso-gastric tube would be placed. After confirming proper placement of the catheter by manometry, the patient is asked to perform 10 swallows of a teaspoon 5ml of water. The muscle contractions of the esophagus, including the upper and lower esophageal sphincters, are then recorded in real-time along the entire length of the catheter for the duration of the swallow. This allows measurement and analysis of not only isolated contraction events, but also the entire swallow as it propagates down the esophagus. 