Nicholas J. Shaheen, MD, MPH, Editor

Ironic then that the esophagus is the focus of so much medical inquiry and is the seat of some of our most common and devastating maladies. I am honored to introduce this issue of Gastroenterology Clinics of North America on benign and malignant diseases of the esophagus. Since this topic was last reviewed 4 years ago, so much has happened in this area. We have seen the epidemic emergence of a major pathophysiologic condition, eosinophilic esophagitis (EoE), which has become the most common source of obstructive dysphagia in some parts of the continent. Revolutions have taken place in the ways that we image the esophagus as well as in the way that we treat neoplastic conditions of the organ. Multiple novel testing modalities have moved from being research tools to being the predominant means of assessing esophageal function.

The most common disorder of the esophagus, gastroesophageal reflux disease (GERD), has also evolved. Whereas the earlier focus of practitioners was on healing the mucosal damage associated with the condition, an increasing awareness has arisen regarding the impact on quality of life associated with ongoing symptoms in the nonerosive patient. Indeed, the battlefield in GERD has shifted from mucosal disease to symptom control, and it is a battle that only the most optimistic would say we are winning.

Despite advances in the care of subjects with esophageal disorders, the epidemic of esophageal adenocarcinoma continues, and this lesion increases in incidence. Our therapies show little impact on survival in this condition, and our attempts at screening and diagnosis for this malady seem to make little dent in the sobering statistics of this cancer––approximately 15,000 of the 17,000 people diagnosed with this condition in 2012 will die of it. As the seventh leading cause of cancer death among men in the United States, the terrible toll of esophageal neoplasia is a beacon to those who treat esophageal diseases, and those who study esophageal disorders. We have a moral obligation to do better by these patients.

This issue of Gastroenterology Clinics of North America has been designed to highlight landmark shifts in the diagnosis and management of esophageal diseases. In a relatively brief space, our esteemed panel of internationally recognized experts brings the general gastroenterologist, surgeon, or interested primary care provider up to speed on the changes in this rapidly evolving area. What are the best endoscopic and surgical treatments of esophageal neoplasia? What is the most logical way to evaluate someone with suspected extra-esophageal manifestations of GERD? What new therapeutic agents can I anticipate for this disease? How should I incorporate high-resolution manometry and impedance testing into my practice? What is the most efficacious management of incident EoE, and what should I do if it doesn’t work? When and how should I screen my patients for esophageal disease? These are not academic questions, but very pragmatic issues that the clinician has a high likelihood of encountering on a daily basis. As such, this volume is designed to be a useful resource in providing your patients with state-of-the-art care for esophageal diseases.

I owe a great debt of thanks to the multidisciplinary team of renowned authors whose work forms the corpus of this volume. I count myself lucky to share a field of interest with such thoughtful, creative, and generous colleagues. Thanks also to Kerry Holland and the staff at Elsevier for their tireless efforts in “herding the cats” to bring this issue together. I hope you enjoy reading the fruits of their labor, and that this work helps you bring better care to your patients.