September 2013 PRINT AND DIGITAL MEDIA REVIEWS 691

REBECCA W. VAN DYKEDepartment of GastroenterologyAnn Arbor VA Health Care SystemAnn Arbor, Michigan

Extraesophageal Manifestationof GERD. Anthony J. DiMarino, Jr,and Sidney Cohen, editors. 136 pp.$46.95. Thorofare, New Jersey, SlackIncorporated, 2013. ISBN: 101-61711-621-1. Web address forordering: www.healio.com

REVIEWER RATING

Coverage of relevant topics

+++

Improvement over previously available media

++

Style of presentation and formatting

++

Quality of figures

++

Overall

+++

Stars:

+: poor; ++: adequate; +++: fair; ++++: good; +++++: excellent.

The nebulous area of the extraesophageal symptoms“possibly” associated with gastroesophageal reflux disease(GERD) has been a vexing issue for clinicians and clinicalinvestigators. The problem is very common and, asrecently suggested by Michael Vaezi, may cost thehealthcare system 4–5 times the yearly expenditure forclassic GERD at $50 billion per year. Admittedly, tradi-tional GERD has been relatively easy to conquer with1 or 2 combatants in the distal esophagus (acid, medi-cations) responding well to proton pump inhibitors(PPIs). Extraesophageal GERD is like the United Nations,with multiple factors and advocates for its cause, be ittobacco, alcohol, allergies, postnasal drip, sinus disease,exercise, changes in temperature, voice abuse, postviralillnesses, inhaled medications, and/or acid reflux. The 2well-respected editors gave me excitement in their intro-duction that the evidence supporting the pathogenesisof these conditions would be critically evaluated in the3 categories of “guilt by association, observed mechanisticstudies, and therapeutic response to treatment.”

Well, what did I like about the book? Most of thecontributing authors have worked in this area. The book iscrisply written, styles are uniform across the chapters, and itis a quick read (no more than 1–2 hours). The first chapterwas a good summary of the pathophysiology of GERD andthe mechanisms by which adjacent organs could beadversely affected and was extensively referenced. Thechapter on the oral manifestation of GERD was especially

well done; the authors had a fresh look at the subject andexcellent dental photographs. The following chapter onextraesophageal GERD in the pediatric population was alsowell done, comprehensive, and expressed a great deal ofskepticism about the role of acid/non–acid reflux in thesepatients. Also, it was refreshing to see a clinical approachwhere pH was tested early rather than wasting 2–3 monthsor more on PPI trials.

Unfortunately, this book was generally a disappoint-ment, as the authors in nearly every chapter just restatedthe “stale” historical facts and did little to address thecontroversies in the area, new evolving technology, andwhere we need to go in the future. For example, neither ofthe authors discussing ENT diseases associated withGERD discussed the artificial conflict between lar-ynopharyngeal reflux (LPR) and GERD, and how thisconfuses our patients. No guidelines were given onwhether to study these patients “on” or “off” PPIs andthe advantages/disadvantages to either approach. Thereseemed to be consensus on a 2-month PPI trial, despitemultiple Cochrane reviews and meta-analyses showing noclinical utility. No one mentioned the new tests in thisarea, which may be potentially useful. These include thepepsin spit assay, acoustic cough monitor, Restech device,and hypopharyneal impedance-pH catheter to moreaccurately measure pharyngeal reflux. Also not mentionedwas lifestyle changes such as low-acid diet and beverages,and the exciting concept that PPIs may be helping somepatients not as antacids, but rather because of their anti-inflammatory properties. Furthermore, there was noguidance on who to treat or what do to if they did not getbetter; that is, endoscopic treatment, baclofen-like drugs,or antireflux surgery.

Add to these glaring omissions, references were rarelycited after 2010 (only 2 for 2012), despite the book beingpublished in 2013. The quality of the illustrations varied,with good ENT and dental photographs, but the high-resolution manometry and impedance pH examplescould have been larger. The tables seemed to de-emphasizethe text by the lighter print quality compared with thedarker bolder titles.

Bottom Line: The authors missed a real opportunityto critically assess the deficits in this area, review newtechnology, and begin to “think out of the box” so wecan evolve in this difficult clinical quagmire. For ageneral historical review, it may meet the need of the GItrainee or nurse. Much better discussions can be foundin recent textbooks (fifth edition of Esophagus) or pa-perbacks (Practical Manual of Gastroesophageal RefluxDisease).

JOEL E. RICHTERJoy McCann Culverhouse Swallowing CenterUniversity of South Florida, TampaTampa, Florida