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Clinicians’ Guide to Inflammatory Bowel Disease

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Clinicians’ Guide to Inflammatory Bowel Disease.Forbes A. (Pp 257; illustrated; £39.50.) London: Chapman and Hall, 1997. ISBN 0-412-7885000-0.

An “intellectual feat by one person achieves a global view of the topic with continuity and balance,” writes John Lennard-Jones in the foreword, and one has to agree. This is a monograph at its best which challenges the Goliath of multi-authored texts. Current literature is thoughtfully interpreted and coherently presented in a way that edited textbooks rarely achieve, forming the foundation for good advice on management.

It is aimed at gastrointestinal trainees and surgeons, as well as non-clinical research workers and specialist workers in the field, but will also be useful to experienced gastroenterologists. The overview of pathogenesis is masterly in its lucid analysis of the different avenues of research. So too are the sections on nutritional therapy, alternatives to steroids, short bowel syndrome, entercutaneous fistulae, extraintestinal manifestations, and the controversial topic of cancer surveillance. For a book of this size (250 pages) it is extraordinarily well referenced (>700); indeed, the references are so up to date that it is mildly frustrating that some landmark papers before 1990 are not mentioned.

Given the style and detail with which complex issues are explained, I found the sections on standard clinical manifestations and treatment relatively superficial. I was not left with a clear impression of a treatment strategy that non-specialists could follow for uncomplicated cases. It is possible that this reflects the tertiary referral practice at St Mark’s, but in a book that excels in presented reasoned data, it would have been helpful to have tales evaluating the trials on steroid and salicylate therapy. More discussion of the common clinical dilemmas of diarrhoea or abdominal pain unrelated to disease activity would also be helpful, as would expansion of the sections on functional aspects, social impact and prognosis. It is a pity that the index and radiograph reproduction are so poor, but this is the responsibility of the publishers who should sort this out for other books in this series.

These are minor criticisms and are measured against outstanding sections of the book, rather than other texts. It must be recommended to all gastroenterologists, trainees, and surgeons. Library copies will walk.Letters, Book review, Notes, Corrections