About the Book

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.

About The Author

Dr. Ravinder Mittal, MD, is a graduate of University of Delhi, India, and has been a resident of the United States since 1978. Following initial training in internal medicine and a three-year clinical and research fellowship in gastroenterology at Yale University, he became an Assistant Professor of Medicine and director of gastrointestinal function laboratory at the University of Virginia, in Charlottesville, Virginia, in 1985. Dr. Mittal rose in ranks and stayed at UVA until 1997. For the last twelve years, he has been a professor of medicine at the University of California San Diego in La Jolla, California. He is a passionate teacher, an empathetic clinician and a keen investigator.

Ever since his first research project in 1983, “Identification and Mechanism of Delayed Acid Clearance in Hiatus Hernia”, Dr. Mittal has remained a passionate translational investigator in the area of physiology and pathophysiology of esophagus. Author of more than 100 original publication, large number of review articles and book chapters, he continues to unravel the mysteries of esophagus. During last twenty-five years of his investigative career, he has made number of seminal observations with regards to the role of crural diaphragm as an external lower esophageal sphincter, transient lower esophageal sphincter relaxation as the pathophysiologic mechanism of reflux diseases and muscle hypertrophy in esophageal motor disorders. For more than ten years, he is keenly investigating the role of longitudinal muscles of the esophagus in health and diseases of esophagus. In 1995 he won the inaugural Janssen Awards in Gastroenterology. Considered to be one of the most important hall marks of a true scientific investigator in medicine, Dr. Mittal’s research has been funded continuously by the National Institute of Health since 1988.

Table Of contents

  • 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 Asbjørn 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


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