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Gastroenterology and Hepatology
  1. M J LANCASTER SMITH

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    Gastroenterology and Hepatology. Edited by Porro GI. (Pp 780; illustrated.) United Kingdom: McGraw-Hill, 1999. ISBN 0 07709 519 7.

    Kurt Isselbacher's foreword to this volume indicates that it was not written for the medical specialist, but rather for the family practitioner and general internist. True, this is not YAMADA. Nevertheless, despite being unreferenced and weighing in at only one quarter of the size of this gold standard text, I believe he is inappropriately modest on behalf of the editors and authors. Although a specialist readership may not have been the primary target, those involved in the daily care of alimentary tract and hepatic diseases will find this book an invaluable addition to the departmental shelves.

    The format is that now commonly adopted for digestive disease textbooks—that is, an initial section dealing with presenting clinical features followed by organ based accounts of specific diseases and syndromes. The final chapters are more broadly based, covering systemic infections, principles of drug therapy, and nutritional support. The emphasis is on presenting the current aetiopathogenic concepts of hepatic, pancreatic, and gastrointestinal diseases and their management, whilst historical and epidemiological perspectives are dealt with more briefly.

    The editorship is in the hands of five very eminent continental Europeans, and only 15 of the 103 authors are from the British Isles. Eurosceptics might be concerned that with a list of authors resembling a Chelsea team sheet, the resulting product might be an uncomfortable read with limited relevance to British practice. Nothing could be further from the truth. The text flows easily, which is a great credit to those authors not writing in their first language. The chapters have a remarkable uniformity of structure, perhaps not surprisingly as this can be readily imposed by the editors, but also of quality, which is predictable in light of the distinguished authorship, and of style. The last of these can have been achieved only by diligent editorial skills, and, I suspect, extensive rewriting. Although the authors are predominantly European, the spelling and approved drug names are from the opposite side of the Atlantic—a concession one assumes to the major potential market.

    Mercifully, guidelines and patient care pathways are not favoured, whilst algorithms are sparingly dispersed. By contrast, the text is regularly punctuated with summarising tables and figures. These will be of particular interest to junior staff preparing their PowerPoint presentations. Hard pressed consultants will be no less enthusiastic, as the book provides a resource for rapid but comprehensive “revision” prior to a training session with the junior staff.

    The chapters covering large bowel polyps and colorectal cancer will be of special value and interest to non-surgeons who have failed to keep abreast of the last decade's developments in the classification and management of these tumours. Recommendations for endoscopic surveillance are discussed, though the authors admit that not all of these are fully supported by adequate evidence yet. Similarly, non-specialists requiring a review of liver transplantation and its place in the final year of the millennium, will be grateful to Ringe and his colleagues for their adroit contribution. The account of ulcerative colitis is a medicosurgical collaboration, which is a feature of many chapters. Medical therapeutic options are fully discussed, but one gains the impression that there may be a lower threshold for elective surgery in German centres than in the United Kingdom. This, however, is a rare example of the possible divergence between British and continental practice. Neville and Axon offer a balanced account of non-ulcer dyspepsia, but, regrettably, the editors have not taken the opportunity of giving this confusing terminology the red card. My men of the match are the Oxford trio for their chapter covering Crohn's disease. I doubt there is a better succinct account currently in print.

    A minor criticism is the rarity of speculation about future developments. It surely would have been timely to have made a few forays into the new millennium.

    Although this book may not be in the champions' league class, it is a thoroughly premiership performance by a team that constantly has its eye on the ball.

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