The Esophagus

THE ESOPHAGUS The Esophagus investigates the anatomy, physiology, and pathology of the esophagus. This sixth edition, revised and updated throughout, also explores the diagnosis and treatment of various esophageal conditions. It includes treatment guidelines approved by the two largest gastroenterology societies, the ACG and AGA, as befits a work co-edited by two former presidents of those organizations. Advancements in diagnostics are presented, as are developments in the surgical and drug therapies. Presented in full colour, and boasting an unrivalled team of editors and contributing authors, The Esophagus Sixth Edition will find a home wherever the anatomy, physiology, and pathology of the esophagus are studied and taught. This book is accompanied by a website containing all the figures from the book in PowerPoint format. www.wiley.com/go/richter/esophagus6e Praise for the Fifth Edition: “There is absolutely no doubt that this edition of the textbook will maintain its status as the go-to reference for esophageal conditions, and will remain a highly utilized and clinically useful resource for novice and experienced physicians and surgeons alike.” (Gastroenterology, 1 July 2013)

Deglutition or a swallow begins as a voluntary act in the oral cavity but proceeds autonomously in the pharynx and esophagus. Bilateral sequenced activation and inhibition of more than 25 pairs of muscles of mouth, pharynx, larynx, and esophagus is required during a swallow. A single swallow elicits peristalsis in the pharynx and esophagus along with relaxation of upper and lower esophageal sphincters. Multiple swallows, at closely spaced time intervals, demonstrate deglutitive inhibition; sphincters remain relaxed during the entire period, but only the last swallow elicits peristalsis. Laryngeal inlet closure or airway protection is very important during swallow. Upper part of the esophagus that includes upper esophageal sphincter is composed of skeletal muscles, middle esophagus is composed of a mixture of skeletal and smooth muscles, and lower esophagus, including lower esophageal sphincter, is composed of smooth muscles. Peristalsis progresses in seamless fashion, despite separate control mechanism, from the skeletal to smooth muscle esophagus. The esophagus's circular and longitudinal muscle layers contract synchronously during peristalsis. Sphincters maintain continuous tone; neuromuscular mechanisms for tonic closure in the upper and lower esophageal sphincters are different. Lower esophageal sphincter transient relaxation, belching mechanism, regurgitation, vomiting, and reflux are mediated via the brain stem. Table of Contents: Introduction / Central Program Generator and Brain Stem / Pharynx-Anatomy, Neural Innervation, and Motor Pattern / Upper Esophageal Sphincter / Neuromuscular Anatomy of Esophagus and Lower Esophageal Sphincter / Extrinsic Innervation: Parasympathetic and Sympathetic / Interstitial Cells of Cajal / Recording Techniques / Motor Patterns of the Esophagus-Aboral and Oral Transport / Deglutitive Inhibition and Muscle Refractoriness / Peristalsis in the Circular and Longitudinal Muscles of the Esophagus / Neural and Myogenic Mechanism of Peristalsis / Central Mechanism of Peristalsis-Cortical and Brain Stem Control / Peripheral Mechanisms of Peristalsis / Central Versus Peripheral Mechanism of Deglutitive Inhibition / Neural Control of Longitudinal Muscle Contraction / Modulation of Primary and Secondary Peristalsis / Neural Control of Lower Esophageal Sphincter and Crural Diaphragm / Lower Esophageal Sphincter / Swallow-Induced LES Relaxation / Crural Diaphragm Contribution to EGJ and Neural Control / Transient LES Relaxation and Pharmacological Inhibition / Compliance of the EGJ / References

“To be up on stage, shoving food in your face, beats everyday existence for most people.” —David “Coondog” O’Karma, competitive eater “Hungry” Charles Hardy. Ed “Cookie” Jarvis. Sonya “The Black Widow” Thomas. Joey “Jaws” Chestnut. Will such names one day be looked back upon as the pioneers of a new manifestation of the irrepressible American appetite for competition, money, fame, and self-transformation? They will if the promoters of the newly emerging sport of competitive eating have their way. In Horsemen of the Esophagus, Jason Fagone reports on the year he spent in the belly of this awakening beast. Fagone’s trek takes him to 27 eating contests on two continents, from the World Grilled Cheese Eating Championship in Venice Beach, California, to Nagoya, Japan, where he pursues an interview with the legendary Takeru Kobayashi, perhaps the most prodigious eater in the world today, and to the Nathan’s Famous Hot Dog Eating Contest at Coney Island, the sport’s annual grand finale, where Kobayashi has eaten more than 50 dogs in 12 minutes. Along the way, Fagone discovers an absurd, sometimes troubling subculture on the make, ready to bust out of its county fair and neighborhood-fat-guys niche and grab a juicy piece of the big-time television sports/Vegas spectacle jackpot. Fagone meets promoters like George Shea, the P. T. Barnum of the International Federation of Competitive Eating (aka IFOCE, “the governing body of all stomach-centric sport”) and enters the lives of three “gurgitators”: David “Coondog” O’Karma, a fiftyish, six-two house painter from Ohio who’s “not ready to become invisible”; Bill “El Wingador” Simmons, the Philly Wing Bowl legend who is shooting for a fifth chicken-eating championship despite the fact that it may be killing him; and Tim “Eater X” Janus, a lean young Wall Street trader who takes a seriously scientific and athletic approach to the pursuit of ingesting mountains of food in record-breaking times. Each in his own way feels as if he has lost or not yet found something essential in life, and each is driven by the desperate hope that through consumption he may yet find redemption, that even in the junkiest of America’s junk culture, true nourishment might be found. After all, as it says on the official IFOCE seal: In Voro Veritas (In Gorging, Truth). With forays into the gastrointestinal mechanics of the alimentary canal (“it’s what unbuilds the world to build you,” but, hey, you can skip that part if you like), the techniques and tricks of the experienced gurgitators (pouring a little club soda on top of high-carb foods makes them easier to swallow), and the historical roots of the competitive eating phenomenon, Horsemen of the Esophagus gives the French something else to dislike about America. And it gives the rest of us food for thought about the bizarre and unlikely places the American Dream can sometimes lead. Also available as an eBook

Barrett’s Esophagus: Emerging Evidence for Improved Clinical Practice is a comprehensive reference on the treatment and new imaging modalities of Barrett’s Esophagus for researchers, clinicians, and scholars. Each chapter is composed from the perspective of investigators who summarize the data as well as the reasoning behind why those studies were conceived. In addition, the future directions of research are discussed within each chapter, providing insights from the investigators. Research questions are described, and cutting-edge applications are explained. Each chapter contains clinical scenarios to highlight the directions in which the research is, and should be, heading. Provides a perspective into the research behind Barrett’s Esophagus Emphasizes the emerging technologies in surveillance and treatment of Barrett’s Features clinical scenarios to highlight the directions in which research is, and should be, heading Includes coverage of current guidelines and discussions on where these guidelines fall short

Atlas of Esophagus and Stomach Pathology provides an image-based resource for those studying normal histology of the upper gastrointestinal tract, as well as the microscopic manifestations of developmental abnormalities, toxic insults, infectious diseases, inflammatory and autoimmune conditions, and neoplasia in the esophagus and stomach. Because modern gastrointestinal pathology practice centers on specimens obtained during endoscopic examination, the atlas focuses on biopsy pathology, providing “real-world” microscopic images and ancillary diagnostic studies for most commonly-encountered abnormalities and diseases affecting these two organs. The book is supplemented with endoscopic and special study images. Authored by nationally and internationally recognized pathologists, Atlas of Esophagus and Stomach Pathology is a valuable tool for both pathologists-in-training seeking to make “new acquaintances”, and practicing surgical pathologists in need of a quick visual reference in recalling “old friends” in the world of diagnostic gastrointestinal pathology.

Gastroesophageal Reflux Disease (GERD) is one of the most common maladies of mankind. Approximately 40% of the adult population of the USA suffers from significant heartburn and the numerous antacids advertised incessantly on national television represents a $8 billion per year drug market. The ability to control acid secretion with the increasingly effective acid-suppressive agents such as the H2 blockers (pepcid, zantac) and proton pump inhibitors (nexium, prevacid) has given physicians an excellent method of treating the symptoms of acid reflux. Unfortunately, this has not eradicated reflux disease. It has just changed its nature. While heartburn, ulceration and strictures have become rare, reflux-induced adenocarcinoma of the esophagus is becoming increasingly common. Adenocarcinoma of the esophagus and gastric cardia is now the most rapidly increasing cancer type in the Western world. The increasing incidence of esophageal adenocarcinoma has created an enormous interest and stimulus for research in this area. GERD brings together a vast amount of disparate literature and presents the entire pathogenesis of reflux disease in one place. In addition to providing a new concept of how gastroesophageal reflux causes cellular changes in the esophagus, GERD also offers a complete solution to a problem that has confused physicians for over a century. Both clinical and pathological information about reflux disease and its treatment are presented. GERD is meant to be used as a comprehensive reference for gastroenterologists, esophageal surgeons, and pathologists alike. Outlines how gastroesophageal reflux causes cellular changes in the esophagus Brings together the pathogenesis of the disease in one source and applies it toward clinical treatment Tom DeMeester is THE leading international expert on reflux disease; Parakrama Chandrasoma is one of the leading pathologists in the area Book contains approximately 350 illustrations Ancillary web site features color illustrations: www.chandrasoma.com

The leading reference text entirely devoted to this increasinglysignificant condition This text is dedicated to Barrett’s esophagus and providesrecent evidence and current approaches to patient management. Ithas been completely revised, updated and extended to include thelatest research findings and describes how these affect day-to-dayclinical practice. It includes seven new chapters and even more color images thanthe last edition. Each chapter, written by the leadinginternational experts in the field, provides clear, didacticguidance on diagnosis, treatment and management of thiscondition. Barrett’s Espohagus gives an extensive overviewcovering epidemiology, screening, pathology, gastroenterology andsurgery. It looks at the precursor lesions leading to thedevelopment of Barrett’s epithelium, the uniquecharacteristics of Barrett’s esophagus, and the consequencesof malignant degeneration. All aspects of diagnosis, secondaryprevention, multimodality, and medical and surgical treatment areclearly explained. This is a complete guide on the latest thinking on diagnosis andtreatment of Barrett’s esophagus which can be referred toover and over again.