Does this textbook teach you why opossums fail to reflux? No. Is it filled with cocktail party pearls about penguin, ostrich, or giraffe esophagi? No. Then who needs an 800-page tome on the esophagus? Who has time to read what 50 expert esophagologists have to say about a 20-cm transit tube? The wealth of information assembled by Donald Castell is a treasure trove for the interested: clinical and academic gastroenterologists, thoracic and general surgeons, and esophageal physiologists. It is not for the esophageal dilettante nor for the faint-of-heart.

Particularly well done is the chapter on esophageal physiology and functional anatomy. The author reduces complex pharyngoesophageal functions (swallowing, transit, and antireflux barrier) into its component parts: voluntary and central nervous system control, skeletal and smooth-muscle contraction and relaxation, and the effects of paraesophageal tissues (pharynx, larynx, diaphragm, intra-abdominal and intrathoracic position of lower esophageal sphincter) on esophageal function. Additional chapters on the laryngeal and pulmonary manifestations of reflux and an excellent review of open and laparoscopic surgical treatment of gastroesophageal reflux contribute much to the reader's knowledge of and perspective on these topics. Curious, however, is the inclusion of a special chapter on esophageal cytology as a diagnostic tool for infectious and neoplastic disease without a concomitant chapter on histology, because the latter is much more commonly used to diagnose esophageal disorders. For instance, no histologic example of esophageal carcinoma is given in the text. More curious still is the devotion of three chapters to the pathophysiology of reflux while other common problems receive rudimentary attention. For example, esophageal rings as the most common cause of intermittent solid food dysphagia are discussed in only two pages. Disappointing also are the endoscopic photographs. Limiting a major esophageal text to 38 color plates of endoscopic anatomy appears stingy in a $200 book, especially because most of the images were captured using fiberoptic technology. The latter is not state-of-the-art and has been almost supplanted by video (CCD: charge coupled device) images in modern endoscopic practice.

Despite these limitations, this second edition of The Esophagus is an invaluable reference source for the serious student of esophagology. For the generalist, the abridged information in a major medical or gastrointestinal text will probably suffice.