Book Review

Review of The Longitudinal Muscle in Esophageal Disease
Originally published in the periodical Radiology

The title of this book is intriguing. With the title of the first chapter being "A Boolean Model of the Esophagus,"

I was sure that this was not a standard text-book!

The basic idea of the book is that the longitudinal muscle layer is responsible fo rmany of the diseases of the esophagus. The promotional literature that arrived with the book stated, "For 33 years, our author kept his peace while patiently testing these and other assumptions daily. He has presented both the logic and the superb radiographs that refute them in a monograph that is the inverted De Motu Cordic of the esophagus."

I was a resident in Australia when Marshall and Warren published a landmark study (Marshall BJ, Warren JR. Unidentified curved bacilli in the stomach of patients with gastritis and peptic ulceration. Lancet 1984; 1311-1315) in 1984 that raised the possibility that the cause of most peptic ulcers was a bacterium. I remember the strident, self-satisfied criticism of this study by well-recognized experts in the field of gastroenterology. When a recent National Institutes of Health consensus conference legitimized the view of Marshall and Warren, the "experts" regretted the earlier criticism. In my review of this book on the longitudinal muscle in esophageal disease, I did not want to repeat the mistakes of "the experts".

I therefore sought the advice of a colleague in the field of gastroenterology who has an interest in motility disorders. He was of the opinion that the scientific literature had been quoted very selectively, and Dr. Stiennon failed to mention references that do not support his theorems. This raises the troubling question as to why the author had "kept his peace" for 33 years. I could find only two papers published by this author on a routine MEDLINE search, although other occasional references that date to the early 1960's are cited.

Even Warren and Marshall fought their battles in the peer-reviewed literature and eventually proved their case.

It troubles me that an author who claims that the medical literature is seriously flawed in so many diseases ranging from Barrett esophagus to achalasia chose to keep this revolutionary information to himself and publish it only after 33 years in a non-peer-reviewed book.

Undoubtedly, some of the ideas in this book will prove correct, and the book should be carefullly studied for these ideas by careful researchers in this field. But it is not for the average radiologist. Anyone interested in this subject would be well advised to consult one of the standard textbooks in the area, such as The Esophagus (Castell DO, ed; Boston, Mass: Little, Brown and Co, 1992).

Reviewed by Neil D. Johnson, MD

Johnson, ND. Book Review: The Longitudinal Muscle in Esophageal Disease. Radiology 1997; 202(2):378.