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Dyspepsia
  1. P Hungin

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We all have a word of advice and the general practitioner is a handy person to give it to. Getting it packaged right can be a challenge, not least when the front cover states that it is an “Indispensable guide to clinical practice”. In this unusual transatlantic collaboration, two distinguished gastroenterologists have made a worthy effort to reach out and have successfully condensed most gastroenterological scenarios faced by the jobbing clinician into an attractive and accessible package. This little book packs a lot—while seeming to be a handy reference it is in fact a repository of facts and information and I confess to dipping into it often to confirm matters or to cull material for a presentation. For example, a map indicating the worldwide prevalence of Helicobacter pylori and tracings illustrating lower oesophageal pressures during swallowing enliven concepts glossed over in other publications.

None the less, the pedigree of the authors does tell on them in some of the sections. Hardly has the invisible ink (from the primary care practitioner’s viewpoint) dried on the Rome II definitions before the one is being exhorted in the chapter on “Functional dyspepsia” to differentiate, on clinical grounds, ulcer-like and dysmotility-like dyspepsia. This is accompanied by advice on tailored regimens based on acid suppression or dysmotility agents. In real life, successful management, one fears, is more likely to be related to serendipity than acumen but there can be no harm in thinking constructively. The “Functional dyspepsia” chapter did rather throw me: the first line defines it as discomfort or pain centred in the epigastrium; luckily I kept at it and further down the page was informed that this only applies where “common or uncommon structural, biochemical or infectious agents have been excluded”. Actually, this angst, and that of further subdividing functional dyspepsia, applies only to those who have heard of Rome II. Most primary care practitioners can thus relax. So can our gastroenterology colleagues who might otherwise be requested to confirm an exact diagnosis of functional dyspepsia in younger patients. Avoiding endoscopy here also avoids opprobrium; alas, the diagnosis of functional dyspepsia must remain in the mind rather than in the investigation suite.

This is the kind of handy book which one needs to receive gratis although I do recommend its purchase if necessary. It is eminently suited to distribution through the good will and thoughtfulness of a pharmaceutical company and I trust that someone will come forward to do this. I do not plan to part with my copy, despite continuing references to prokinetic drugs which are no longer, or were never, available in the UK.

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