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Inflammatory Bowel Disease: From Bench to Bedside, 2nd edn
  1. S Ghosh

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Edited by S R Targan, F Shanahan and L C Karp. Dordrecht: Kluwer Academic Publishers, 2003, £219, pp 903. ISBN 1 40200 713 2

Few diseases can lay claim to four large multiauthor textbooks in addition to numerous more concise handbooks and monographs. This is certainly unique in gastroenterology where inflammatory bowel disease (IBD) has attracted eager basic scientists, clinicians, and the pharmaceutical industry with a frenzy of translation from bench to bedside. The concept of “boundary less”, so effectively developed by Jack Welch as the CEO of General Electric Co, aptly describes current IBD research, where geneticists, epidemiologists, immunologists, microbiologists, and molecular biologists interact seamlessly with gastroenterologists, physicians, health economists, and nurse specialists.

Three additional questions posed in this second edition, over and above those posed in the first edition, hold the textbook together very well. These are stated by the editors as: (a) Based on understanding derived from a wide range of animal models, are Crohn’s disease and ulcerative colitis different expressions of the same disease or are they discrete entities? (b) Do infectious agents have a role in the aetiology or pathogenesis of inflammatory bowel disease? (c) Where is research taking us and how will it change the management of inflammatory bowel disease?

Section 1 covers epidemiology and laboratory research, and in addition to the usual journey through genetics, immunology, animal models, and microbial interactions, contains useful chapters on the effect of inflammation on intestinal function and systemic consequences, as well as intestinal healing and repair. Brief description of the new cytokines interleukin (IL)-20, IL-21, IL-22, and IL-23 are provided, as well as interesting molecules expressed on intestinal epithelial cells such as the CD1 family of proteins. Some key immune cells are perhaps less well covered than expected, such as dendritic cells. Nevertheless, the first section should get all readers up to speed in basic scientific aspects of IBD research.

“The bedside” covered in section II is probably the greatest strength of the book. The chapters covering clinical aspects are uniformly written with superb insight and analysis, and are more than a mere representation of established facts. The endoscopy section suffers from a lack of colour photographs but the imaging section is very well illustrated. Medical and surgical managements are comprehensively covered and illustrate how rapidly these are changing. Paediatric perspectives are provided. Management options are discussed at a very practical level but provide enough scientific background necessary for wise application. This makes the textbook very accessible for all practising gastroenterologists managing IBD. Keeping in mind the intended readership, the book also provides valuable chapters on microscopic colitis, intestinal ischaemia, diversion colitis, pseudomembranous colitis, and infectious colitis, all conditions that may be mistaken for IBD.

The final section attempts to answer the last question posed above, and discusses the enormous pace of translation and the challenges of such a rapid pace of development. Genomics, phenomics, and proteomics will all strive to target a limited pool of patients, and prioritisation based on science rather than pharmaceutical expediency is a major challenge. Altering the natural history of IBD is here to stay and one wonders whether the third edition will be in a position to describe the cure. This book must be considered an essential acquisition for all medical libraries, institutional or departmental, and in addition should be on the shelves of researchers and clinicians dealing with IBD. IBD currently almost fulfils Voltaire’s quotation—“The multitude of books is making us ignorant”—but this certainly is one book on the subject worth having. It is comprehensive but not encyclopaedic, a tribute to editorial discipline.

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