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Gastrointestinal pharmacology and therapeutics

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Gastrointestinal pharmacology and therapeutics.Friedman G, Jacobson ED, McCallum RW. (Pp 930; illustrated; $183.00.) Philadelphia: Lippincott-Raven Publishers, 1997. ISBN 0-397-51625-8.

Considering the major advances in gastrointestinal therapeutics in recent years, it is timely that a new book dedicated to gastrointestinal pharmacology and therapeutics should be published.Gastrointestinal Pharmacology and Therapeutics consists of 59 chapters divided into 15 sections on all aspects of gastrointestinal pharmacology. In fact, there is considerable emphasis on gastrointestinal pathophysiology so the book could easily be calledGastrointestinal Pathophysiology, Pharmacology and Therapeutics. It is written almost exclusively (apart from a token European), by American based gastroenterologists and pharmacologists and thus has quite an American feel to it.

The opening chapter discusses the fundamentals of gastrointestinal pharmacology. In other general pharmacology text books the section mainly dealing with pharmacodynamics and pharmacokinetics is generally avoided by students in the hope that they won’t get asked about this in examinations! However, in this book, the chapter is well illustrated and deals with the subject without being too stodgy. The book then goes on to go through the gastrointestinal tract starting with upper GI tract diseases leading with a chapter on helicobacter which mainly deals with the pathogenesis rather than treatment. The book follows a fairly predictable course going through treatment of oesphogeal reflux, gastric and duodenal ulcers and drug induced ulcerogenesis. Information given here for the most part is also acceptable this side of the water. There are, however, some inconsistencies. For example, in the chapter on drug induced ulcerogenesis it is recognised that “it is unknown whether an synergism exists between H pylori and NSAIDs to increase ulcer diathesis”, it then goes on to recommend eradication of H pylori for all patients on NSAIDs. There is a comprehensive section on the physiology and pharmacology of gastrointestinal motility disorders which is generally well written although the diagrams are in slide form with a black background and often quite difficult to make out.

There is an excellent chapter on the pharmacology of small bowel infections which contains a lot of information on both viral and bacterial gastroenteritis and has a useful table on current antibiotic treatments for these conditions. There is also a useful up-to-date section on AIDS and the gut which deals with the oesophagus, stomach and colon in separate chapters.

The section on inflammatory bowel disease conveniently divides up treatment into commonly used agents in inflammatory bowel disease and drugs for which fairly minimal data are available or are still in the experimental phase. It then goes on to discuss the medical management of Crohn’s disease and ulcerative colitis in separate chapters. Both acute and chronic liver disease are then dealt with, with considerable emphasis on the pathophysiology of these conditions. Other chapters deal with acute and chronic pancreatitis, the pharmacology of bowel ischaemia and the use of drugs in pregnancy and old age. The concluding chapters are on the drug development process including an informative chapter on FDA regulations. It even contains a chapter on the role of the pharmaceutical industry in drug development along with some advice for would be researchers on setting up clinical trials in gastroenterology and therapeutics.

This book is primarily aimed at practising clinicians dealing with day-to-day management of gastroenterological problems but who may not have the time or resources for more extensive literature researching. In the foreward of this book it is stated that the problem of information overload is solved by this book. However, a major criticism of the book would be that there are too many chapters, many devoted to pathophysiology of various conditions which are covered comprehensively in many other general text books. For example, in the section on sphincter of Oddi pharmacology there is a whole chapter in the physiology of the sphincter of Oddi with one short paragraph on therapy.

Despite these reservations, this is a general, comprehensive text book on gastrointestinal pharmacology and therapeutics and overall it is a worthy addition. It is also bound in a handsome dark green cover and priced at $183.00 it is not particularly expensive for this type of book. No doubt this volume will be added to the library of many practising gastroenterologists, especially in the USA!

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