Читать книгу The Esophagus - Группа авторов - Страница 11

Donald O. Castell MD

Professor Emeritus, Medical University of South Carolina, Charleston, South Carolina, USA

My exposure to studies of esophageal function began in the middle of the twentieth century and reflects 50 years of clinical experience and testing using new technology. There was growing interest in the development of techniques to study in vivo; function of the human esophagus. Early pioneer work in the laboratory of Charles Code, PhD, at the Mayo Clinic led the way, with studies using nasogastric intubation with small (2–5 mm diameter) catheters in both healthy volunteers and patients with symptoms likely related to esophageal motility abnormalities. These studies were performed in awake, non‐sedated patients with a limited number of swallows (traditionally 10) of 5 ml volumes of water or saline, using a catheter filled with water or a small air‐filled balloon.

In the 1950s and 1960s, a growing group of enthusiastic investigators joined the ranks of Code’s disciples, expanding awareness of manometric findings in patients presenting with dysphagia, regurgitation, heartburn, or chest pain so that by the end of the twentieth century, the terms esophagology and esophagologist were often seen. This was stimulated by their use at the regular international meetings for studies of the esophagus organized every two to four years by professor Robert Guilli, a Parisian surgeon. At one of these, he organized an election such that I was voted by my international colleagues to receive the title “Pope of Esophagology.” Although it was created in jest, I have enjoyed the respect it carries for many years. I believe that an esophagologist is best defined as a basic or clinical scientist with a focus on studies of esophageal function or disease.

The early and subsequent group of us included Ray Clouse, Wylie Dodds, Sidney Cohen, Peter Kahrilas, John Dent, Charles Pope, Prakash Gyawali, Radu Tutuian, and Marcelo Vela. It was my good fortune during those years to work with my co‐editor, Joel Richter, who became my academic inspiration. In this case, the mentor clearly became the mentee.

These clinical investigators were joined by an enthusiastic group of basic scientists including Raj Goyal, Norman Weisbrodt, Nick Diamant, Andre Smout, Ravinder Mittal, and Jim Christenson. In the early years, we had our annual informal meeting of the “gullet club” on Monday of DDW in the bar at one of the participant hotels, usually starting after 9 p.m. From these humble beginnings, the American Neurogastroenterology and Motility Society (ANMS) has emerged.

I was often amazed at the growth and popularity of the gullet club. Over the years, I have come to appreciate the two essential reasons for the emerging legions of esophagologists: it is not simply due to a groundswell of interest in the organ but rather its ready accessibility by a simple nasogastric intubation that allows access to GI tract smooth‐muscle responses. Additionally, one should not underestimate the value of functional evaluation of an organ that performs “on‐demand” in response to a swallow. The continued popularity of studies on physiology and pathophysiology remains satisfying as new technologies and potential therapies are developed. At present, there is great enthusiasm for the technique of per‐oral endoscopic myotomy (POEM) as therapy for complicated esophageal dysmotility. I hope the world’s esophagologists will remember what history has taught us about the devastating reflux that can result from an overly zealous myotomy at the esophagogastric junction and respect the relation of enthusiasm over time for new and evolving diagnostic or therapeutic approaches such as POEM.

It has been a pleasure to observe and participate in the evolution of technology in the field, from Dr. Code’s fluid‐filled catheters and hand‐me‐down recording devices to solid‐state high‐resolution manometry with computer‐driven analysis programs. The thoughtful and focused work by John Pandolfino and Peter Kahrilas has championed an international consensus group to classify the results of studies obtained using this new technology.

We are perpetually grateful to the late Ray Clouse for the early development of high‐resolution technology. We have come a long way!