It is a pleasure to express to Mr. Gilles Cahn, manager of Editions
John Libbey Eurotext (Paris and London) as well as his entire team,
particulary Ms Boulanger, Coche and Duval, the gratitude I feel for
the production of this work.
I am aware that the sum total of our unending demands for this book,
from the printing delay, the minutest details of the make-up of every
page to its very construction and presentation, have been very heavy
and continuously stressful from the time of our first meeting.
I can only say that I have met with nothing but an unreserved understanding
in this publishing house, and an enlightened competence, offered freely
and graciously, to help us in our work and thus to enable us today to
present a production of rare technical quality.
It is a renewed pleasure for the Honorary President of OESO to have
the duty, as after each of its Congresses, of presenting a new book
from this international Organization for statistical studies of diseases
of the esophagus.
The first two books were published in 1984 and 1987, inaugurating
an unprecedented formula bringing together the experience of a number
of specialized teams throughout the world.
Such a formula, conceived by Robert Giuli, diligent organizer of these
studies and indefatigable coordinator of the various syntheses expounded
by the participants, was arranged around questions previously posed
by himself, each with a very specific objective.
Thus, there were answers to 135 questions in 1984, and to 210 in 1987.
I can state, as a pioneer of esophageal surgery in France 50 years
ago and as a clinical pathologist of esophageal disorders, then almost
unknown, that I find the information drawn from these two works quite
And now, in 1991, we have the production of a new text with 450 questions!
Obviously, this book is no longer a simple volume containing the proceedings
of a Congress; rather, it consists of the elaboration, after a truly
worldwide enquiry, multicentered, managed and controlled throughout
by Robert Giuli, of a study extending far beyond the previous productions
of OESO on cancer or benign lesions of the esophagus.
In fact, the study of the primary motor disorders of this «
hypersensitive » organ confirms, while at the same time advancing,
many previously acquired or developed concepts.
The extraordinary progress in biophysical investigation of the esophagus
means that this work may be regarded as a major event in the history
and knowledge of the biophysico-medico-surgical pathology of the esophagus.
It is a true encyclopedia of the pathology of the esophagus which
has just been produced, based on varied, judicious and pertinent questions,
studied collegially, and posed with the shrewd perspicacity to be expected
from that reknown practitioner of esophageal surgery, Robert Giuli.
We thank him for this new step forward and the credit it bestows on
President of Honour of OESO
In June 1990, an extraordinary event occurred in Paris.
For an entire week, international authorities from multiple specialties
gathered together to present data and answer questions concerning esophageal
This Congress, sponsored by OESO under the leadership of Professor
Robert Giuli, was the most intense examination ever given to these poorly
understood and troublesome conditions.
The format for this Third International Polydisciplinary Congress
sponsored by OESO was similar to that introduced in the two previous
Congresses held in 1984 and 1987, and is a unique contribution introduced
by Professor Giuli.
The series of specific questions is designed to address a subject
in a comprehensive and logical sequence. Experts known to have specific
data or strong opinions are invited to provide the answer to a question
in a brief response, usually three to five minutes.
As related groups of questions are answered, there is an interval
for discussion from all participants.
Such a meeting provides maximum information for the audience in the
time allowed, and is particularly effective for a multi-disciplinary
This format also provides the basis for a comprehensive well-organized
book on the subject. With typical Gallic persistence and intensity,
Professor Giuli has pursued all of the respondents to 450 questions
about motor disorders to submit their answers in writing, and has produced
this remarkable book in near record time following the Congress.
Among the esophageal motility disorders, achalasia is perhaps the
best defined, but controversy persists concerning the precise diagnosis,
lack of specific correlation between microscopic pathology and the clinical
presentation, and the indications and methods for treatment.
When so much is uncertain about the best known condition in this group
of disorders, it is not surprising that even greater confusion and controversy
surrounds the other related conditions covered in this Symposium.
These include oropharyngeal dysphagia or achalasia of the superior
esophageal sphincter, diffuse esophageal spasm, the « nutcracker
» esophagus with high peristaltic amplitude, the several types
of esophageal diverticula which are now known to be part of the spectrum
of motor disorders, causes of non-cardiac chest pain of esophageal origin,
and the relationship of motility disorders to gastroesophageal reflux.
The current state of knowledge and theory about each of these conditions
is covered in the questions and answers including anatomy, pathology,
histology, ultrastructure, physiology, diagnostic methods, classification,
correlation of symptoms with objective findings, indications for treatment,
and treatment methods including pharmacology, surgery, and dilatations,
and finally the complications of the diseases and their treatment.
The result, when presented in this format, is an encyclopedic coverage
of a complicated subject with answers concisely given by the world's
foremost experts on the subjects from the fields of gastroenterology,
endoscopy, thoracic and general surgery, otolaryngology, radiology,
pathology and physiology.
This book thoroughly covers that which is known on this subject as
of 1991 and will serve as a foundation from which future developments
and knowledge will evolve during the next decade.
This volume should stand as the most comprehensive coverage of esophageal
motor disorders yet available.
It will be a basic reference source for physicians of all disciplines
who are students of this subject, or for practitioners called upon to
diagnose and treat patients with these difficult conditions.
Professor Giuli is to be congratulated for the success of the format
which he has developed for international Polydisciplinary Congresses
and his effective transposition of this into an outstanding book.
It has been a privilege, along with Professor Rene Lambert, M. Ronald
Belsey, and Professor J.-L. Lortat-Jacob, to serve with Professor Giuli
in the organization of this Congress.
David B. Skinner M.D., Dsc (Hon) FACS
Professor of Surgery
President of the New York Hospital
Cornell Medical Center
The OESO Congress has become an institution, thanks to the generosity
and exertions of Robert Giuli.
In June 1990, he brought together a constellation of specialists in
the disorders of the esophagus, for the third time at intervals of 3
years. He succeeded in finding an original form of presentation by volleys
of short questions accompanied by equally short answers, the whole providing
a coherent view of a sector of physiopathology and pathology in a multidisciplinary
Nor did Robert Giuli stop at promoting a periodic international spoken
discussion, for he then devotes himself to the publication of what amounts
to a bible on the theme of the Congress.
This presentation supplies the international readership with an exhaustive
analysis of the state of our knowledge.
After cancer of the esophagus and after benign lesions of the esophagus,
here, OESO III provides a global view of the motor disorders of the
While tumors and reflux constitute the high point of the majority
of meetings devoted to the pathology of the esophagus, disorders of
motility are usually accorded a much less prominent position. This caution
is now out of place ; indeed, the physiopathology of gastroesophageal
motor coordination has now become clearer, while the pharmacological
actions of medication have at last become subject to measurement and
The reader will find in this book all the questions and answers to
do with normal motor function of the esophagus, together with the corresponding
anatomic and physiologic basis, as well as a critical study of procedures
for measurement of peristalsis.
The different aspects of the pathology of motility are presented in
similar analytic fashion. Besides such well-defined disorders as achalasia,
diffuse esophageal spasm, diverticula and the motor disturbances associated
with esophageal reflux, the reader will find all the modern concepts
related to still ill-defined motor disorders, such as achalasia of the
upper esophageal sphincter, painful peristalsis (the so-called nutcracker
esophagus), the motor disorders associated with pseudoanginal pain and
the motor disorders found in senescence.
The therapeutic spectrum is also extensively dealt with : methods
of instrumental dilatation, surgical myotomy, prokinetic pharmacologic
agents interfering with neural and humoral control (aminergic, serotoninergic
and histaminergic neurotransmitters), digestive and opioid peptides,
and agents interfering in the interplay of contraction and relaxation
(modulators of ion flow, propotassium agents and calcium-blockers, modulators
of cyclic endocellular messengers).
We have to thank Robert Giuli, the true inspirer of this coordinated
international activity, steadily maintained over the last 12 years.
His actions have contributed to the advance in knowledge by bringing
together specialists in this organ from all over the world.
Moreover, he provides his fellow gastroenterologists in France with
the opportunity of attending these productive meetings every 3 years.
I hope that he will continue his activity, and that he will plan OESO
IV and its accompanying book with the same success.
Professor of Medicine
Past President of the French Society of Gastroenterology and the French
Society of Digestive Endoscopy
The genesis for this book dates to the gathering in Paris from June
19-23, 1990, for the Third International Congress of OESO, under the
masterful organization and moderation of Professor Robert and Mrs Patricia
The presidential leadership of Drs David Skinner and Rene Lambert,
together with the President of Honor of the Congress, Mr Ronald, H.
Belsey, guided us in integrating a polydisciplinary approach to a major
topic in gastroenterology ; namely, the primary motility disorders of
This book reflects the state-of-the art in this area relating to the
fields of anatomy, physiology, gastroenterology, endoscopy, pathology,
psychological aspects, and surgery.
The world's most recognized investigators, authors, and clinical experts,
representing over 20 countries, have contributed to a landmark publication
which, as the 1990's begin, is clearly the foremost international reference
book for esophageal motility problems.
I am Australian, Dr Giuli, French, and Dr Skinner, American, so truly
international editorship sets the tone for achieving this goal.
The foresight, perseverance, commitment and genius of our host and
principal editor of this book, Robert Giuli, is exhibited throughout
the organization of this text. This hithertofore unappreciated approach
to a medical book is based on assembling a succession of replies to
questions specifically focused in logical order.
This has resulted in a dynamic approach to textbook reading, providing
the reader with a sense of the atmosphere of active debate and scientific
exchange which the question and answer format provides.
Dr Giuli's concept of a textbook sets a new standard of appreciation
for crisp, concise responses to the major questions that investigators,
clinicians and patient care providers are asking about the esophagus
In the jargon of the United States popular publishing press, this
book would equate to « everything you wanted to know about esophageal
motility disorders but have been afraid to ask ».
Every basic and small detail is addressed as the intensity of the
questions mount and the complexity of the answers build, providing one
with a feeling that having completed this enjoyable reading, one is
fully satisfied that one has successfully « swallowed »
the knowledge of the world's experts and is fully equipped to venture
into the 1990s.
Perhaps another way of looking at it would be to say that readers,
having finished this textbook, will be able to « swallow »
more easily, in the knowledge that for this 20 cm organ they now have
more information on the esophagus per cm than for any other organ in
the GI tract.
If that goal has been attained, then I am very happy as one of the
co-editors to recommend this truly international textbook on esophageal
motility disorders to medical students, house officers, internists,
surgeons, gastroenterologists, radiologists, pathologists, pharmacologists,
as well as our colleagues in basic and physiologic research.
Please bring this information to the patient's bedside as you pursue
our common goal of improving patient care by ameliorating esophageal
Richard W., McCallum, M.D., FACP,
FRACP (Australia), FACG
Professor of Medicine
Chief of the Division of Gastroenterology
University of Virginia
When I had established the 450 questions that form this text, I endeavored
to ensure that, in each specialty, the motor disorders of the esophagus
were separated, cut up, broken down into a multitude of facets which
would allow the greatest possible practical understanding of this vast
field of pathology.
After having drafted the last of the questions comprised in the contents
of this book, a great deal of thought was required in composing the
list of the 200 specialists, most of them giants in their specific areas,
to reply to one or more of these questions, in the aim of producing
a critical synthesis on a very precise instance of their experience.
Coming from 20 countries, all these selected figures accepted this
difficult task, and it is this collective enthusiasm that now gives
me the great satisfaction of presenting this third volume of OESO, which
continues in the exact path in which it set out: international and multidisciplinary
The exceptional character of David Skinner, his international stature,
and all he contributes to our profession, the noted scientific reputation
of Richard McCallum, add to the lustre of this book.
The faithful friendship of each one is precious to me.
It is to my greatest satisfaction today to be able to express mine
in return, and to let them know how much value I attach, as do all the
readers, to their names this volume bears as co-editors.
Whatever his specialty, the reader interested in the motor disorders
of the esophagus has an exceptional synthesis at his disposal here.
On opening this book at random, or consulting the detailed index,
he should be able to find straightaway the detail he is seeking, the
relevant opinion his is acking, or even the development of a question
which he may not yet have asked himself.
Robert Giuli, M.D., FACS, FCCP
Professor of surgery
A volume of this breadth and scope could certainly not have been achieved
without running into some slight difficulties, without demanding a certain
perseverance, even unremitting effort, and without having to deal with
an infinite variety of daily problems.
From the very conception of this book, to its preparation, and finally
to its realization, I was fortunate to benefit from the irreplaceable
structure of the Association Internationale pour la Recherche Medicale
et les Echanges Culturels.
The core and soul of this Organization — Michele Liegeon — gave me
invaluable work through her enthusiasm, her rigour, and her far reaching
intelligence. Only an exceptional personality of dedication like her
could have assumed such a task.
She participated fervently in each aspect of every line.
May I express my gratitude to her for all she gives and contributes
each day, and has given, since the beginning, to the forward drive of