Objective: To highlight the contributions from the University of Chicago under the leadership of Dr David B. Skinner to the understanding of gastroesophageal reflux disease (GERD) and its complications.
Background: The invention of the esophagoscope confirmed that GERD was a premorbid condition. The medical world was divided between those who believed in a morphological lower esophageal sphincter (LES) and those who did not. Those who did not believe attempted to rearrange the anatomy of the foregut organs to stop reflux with minimal success. The discovery of the LES focused attention on the sphincter as the main deterrent to reflux and the hope that measurement of a low LES pressure would mark the presence of GERD. This turned out not to be so. In July 1973, with this history of confusion, Dr Skinner at the age of 36 assumed the chair of surgery at the University of Chicago.
Methods: The publications of the University of Chicago's esophageal group were collected from private and public (PubMed) databases, reviewed, and seminal contributions selected.
Results: Twenty-four-hour esophageal pH monitoring led to the understanding of the LES, its contribution to GERD, and the complication of Barrett's esophagus. The relationship of Barrett's to adenocarcinoma was clarified. The rising incidence of esophageal adenocarcinoma led to contributions in the staging of esophageal cancer and its treatment with an en bloc resection.
Conclusions: Ten years after the death of Dr Skinner, we can appreciate the monumental contributions to benign and malignant esophageal disease under his leadership.
Advances in technology are mirrored by an improved understanding of pathophysiology. Few individuals understood this better than Dr David B. Skinner. During his tenure at the University of Chicago, he established a scholarly environment and recruited faculty interested in the esophagus. This report reviews their greatest contributions.
*Keck School of Medicine of the University of Southern California, Los Angeles, CA; and
†University of Chicago Pritzker School of Medicine, Chicago, IL.
Reprints: Tom R. DeMeester, MD, Department of Surgery, Keck Medical Center of USC, 892 Huntington Garden Drive, San Marino, CA 91108. E-mail: Tom.DeMeester@med.usc.edu.
Disclosure: The authors declare no conflicts of interest.