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Helicobacter pylori
  1. S MOSS

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Helicobacter pylori. Harris AW, Misiewicz JJ. (Pp 66; illustrated; £9.95.) London: Blackwell Healthcare Communications, 1996. ISBN 0-86542-639-2.

Is there anyone left who would like more information onHelicobacter pylori, or has saturation point been reached? According to my local virtual bookstore (, there are currently 22 book titles available dealing specifically with this germ, in addition to thousands of research papers and hundreds of reviews and editorials in the specialist and general literature. So, why do we need another book, especially when the guidelines for treatment seem to change every few months? For those who are sceptical (as I was initially), let me persuade you that in this small paperback of 66 pages Drs Harris and Misiewicz have served a very useful role in educating UK general practitioners on the management of their patients.

This user-friendly book slips into a white-coat pocket easily and could be read in an evening. It contains all the essential information, from epidemiology and pathophysiology through to who and how to treat. It is well, but not overexcessively referenced, has useful summary sections (which could easily be the basis for MRCP-type MCQs), and offers guidelines without dogma. The latter is the book’s strength, but also its weakness, because by making (mostly correct) generalisations about the treatment of H pylori, the authors run the risk of not being sufficiently specific. For example, a variety of eradication regimens are listed, but no best bet is recommended. Thus, the authors will certainly not offend any researcher or pharmaceutical company, but this generosity may be less than helpful for the busy practitioner, who needs to know what to write on the prescription pad.

The other problems with any treatment guidelines, especially forH pylori, are that the goalposts move, and that H pylori may have different implications in different populations. Who would have anticipated, writing in 1996, that up to 25% of duodenal ulcers in the United States may be unrelated to H pylori, or that both the 1997 International Update Conference and the 1997 “Maastricht” consensus would recommend offering treatment to all patients found to have a positive test? Thus, although representing the “state of the art” when written in 1996, the book already seems a little dated.

So, as much of the information in this primer has a short half-life, we can anticipate a second edition. I would like to see some more appealing figures (the colour photos especially, which take us back to the bad old days of fibreoptic endoscopy) and a more basic introductory chapter as the current chapter one simply summarises treatment guidelines. As this book is written very much for the home market, it is much less useful to those in other countries, particularly when the relative costs of alternate clinical strategies may be wildly different.

However, despite these caveats, this book will be useful to those still struggling to define the relevance of H pylori in their clinical practice. This should by now include gastroenterologists and junior doctors, and in addition to the target audience of GPs, may encompass general medicine physicians and surgeons. Finally, it will undoubtedly be of interest to the scientifically literate patient, especially if they still prefer to read books than to download from cyberspace.