This report describes repetitive contractions in the upper esophageal sphincter (UES) and the repetitive upper esophageal spontaneous contractions (RUESCs) of patients with achalasia and relates this activity to repetitive contractile activity (RCA) recorded in the more distal esophageal body, to intraesophageal pressure (IEP), and to lower esophageal sphincter (LES) pressure. Two hundred and sixteen consecutive esophageal motility studies from 156 achalasia patients with retrospectively assessed. RUESCs were found in 105 patients (67%) and 125 of 216 studies (58%). General features of the RUESC were (1) coincidence with simultaneous repetitive increases in pressure throughout the entire esophageal body; (2) amplitude of pressure increases tended to be higher in the proximal esophagus; (3) RUESC frequency was different than respiration, except for 6 cases where continuous, RUESC and RCA were synchronized with inspiration; and (4) RUESCs were positively associated with increased IEP, and with increased LES pressure (> 40 mmHg). RCA in the esophageal body was uncommon without RUESC. It is concluded that (1) RUESCs are common in achalasia and appear to be closely linked to contractile activity in the upper esophageal body; (2) the close relationship of RUESC and RCA in the esophageal body to increased IEP and elevated LES pressure suggests that esophageal tone is high in these subjects; and (3) these findings indicate a potential mechanisms for localization of some of the clinical symptoms to the retrosternal and suprasternal areas, for the inability to readily belch, and for the development of structural features such as a prominent cricopharyngeal bar.