During the last quarter century, there has been an explosion of knowledge in the areas of visceral and esophageal pain. The effectiveness of acid inhibition drugs (proton pump inhibitors), still the mainstay of treatment, is increasingly questioned as significant numbers of patients show little benefit from such therapy. Newer mechanisms of esophageal pain have been uncovered during last twenty years and it is quite clear that novel approaches are emerging in the treatment of pain. Comprising contributions for leading expert authors, this is the first in-depth coverage of all aspects of esophageal pain. In great detail, chapters cover the scope of the problem; basic science - with regards to the nature of neural pathways, receptors involved in sensing pain and the role of central nervous system in sensing the pain; different stimuli responsible for the genesis of esophageal pain, including the role of acid, muscle spasm and reflux; hypersensitivity of pain receptors, spinal nerves and central nervous system; current state of the art in diagnosis and treatment strategies; and, lastly, newer pharmacological treatments currently in research and trial stages.
Ravinder Mittal, M.D. Professor of medicine at the University of California San Diego in La Jolla, California.
Introduction 1. Heartburn and Esophageal Pain - Scope Of the Problem John Dent 2. Functional Heartburn: What Is It? Ronnie Fass The Basics of Pain 3. Nature of Esophageal Pain Receptors Amanda J. Page and Ashley Blackshaw 4. Vagal and Spinal Distension Sensitive Primary Afferents of the Esophagus: Implications for Visceral Nociceptors Raj K. Goyal Stimuli of Esophageal Pain 5. The Esophageal Mucosa and Heartburn Roy C. Orlando 6. Neutral Reflux (weakly acid) in Typical and Atypical GERD Symptoms Daniel Sifrim 7. Longitudinal Muscle Contraction, TLESR, Reflux & Pain Ravinder Mittal 8. Biomechanics of Sensation Hans Gregersen and Asbjorn Mohr Drewes Peripheral and Central Mechanisms of Sensitivity and Hypersensitivity 9. Molecular Pathways and their Sensitization Pankaj Jay Pasricha 10. Cortical Processing of Esophageal Pain Adeyemi Lawal and Reza Shaker 11. Esophageal Hypersensitivity; is it peripheral or central? A. Sharma and Qasim Aziz Diagnosis and Management of Esophageal Pain 12. Diagnostic Strategy for Esophageal Pain Peter J. Kahrilas 13. How to Treat Esophageal Chest Pain Satish S.C. Rao 14. New drugs on the Horizon for the Treatment of Esophageal Pain Anders Lehmann