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This short book brings together an international group of experienced researchers in the field of oesophageal pain. The two main clinical scenarios are those of heartburn and so-called ‘non-cardiac chest pain’.
The concept is admirable although, as the editor comments in the foreword, there is no unified point of view and some disagreements (and indeed some duplication) are evident as one reads through the chapters. The contributions are grouped in sections, beginning with two overview chapters (including a typically insightful commentary from Professor John Dent). I found the chapter on functional heartburn, although full of useful data, a little frustrating. Rome III has ‘split’ functional heartburn into two subgroups: patients with normal amounts of gastro-oesophageal reflux and a positive symptom/reflux correlation (‘the acid-hypersensitive oesophagus’) and those with normal amounts of reflux showing no relationship between symptoms and reflux (now termed ‘functional heartburn’). Most of the research to date has combined these two groups together as they were not differentiated in the Rome II definition which most recent published research has used to define study groups. Two of the next sections deal with basic science—pain pathways and receptors, including up-to-date information on receptor subtypes and the neural pathways which may be involved in modulation of oesophageal pain, together with evolving concepts of peripheral and central sensitisation from both the molecular and physiological standpoints. I particularly enjoyed chapters on neural pathways (Goyal and Choudhury) and central/peripheral sensitisation (Sharma and Aziz). There is a section on mechanisms of pain—the chapters on the response of the oesophageal mucosa to acid and longitudinal muscle spasm both stand out for their clarity.
The book finishes with chapters on the investigation and management of heartburn and ‘non-cardiac chest pain’: both give up-to-date advice on how clinicians should investigate and treat such patients in the light of current knowledge. It is disappointing, however, to realise how slowly research has translated into improved clinical care (functional heartburn is a case in point), and how weak is the research basis for some of our current management strategies (eg, use of tricyclics or selective serotonin reuptake inhibitors for pain modulation). The book finishes with an overview of potential drugs in development and targets for future development (although clearly there may be many more interesting targets to emerge as basic understanding is refined, as indicated in the earlier chapters).
I found the inclusion of all the colour plates in a section in the middle of the book slightly irritating, as the reader has to keep turning to these when reading the chapters to which they refer.
Who is this book aimed at? While a few of the chapters (especially the first and last sections) will be of interest to a wide clinical readership, the chief value is the juxtaposition of basic science and applied clinical research. This makes it an essential book for new (and even experienced) researchers in this field. Although, by their very nature, books of this sort tend to be superseded within a few years as knowledge advances, since it contains such a wealth of diverse information pulled together into a slim volume, I suspect it will be a starting point for those entering the field of clinical research in this area for many years to come.
Competing interests None.
Provenance and peer review Commissioned; not externally peer reviewed.
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