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Inflammatory Bowel Diseases and Chronic Recurrent Abdominal Pain
  1. D C A CANDY

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Inflammatory Bowel Diseases and Chronic Recurrent Abdominal Pain. Edited by Hadziselimovic F, Herzog B. (Pp 221; illustrated; £66.00.) Dordrecht: Kluwer Academic Publishers, 1997. ISBN 0-7923-8722-8.

I have yet to attend a Falk Symposium but it seems likely to be an agreeable experience. The ability to consider the big questions of biomedical science in a multidisciplinary setting is not to be missed. Perhaps if I write a good review I might be invited to the next one!

Symposium 91 considers two very important gastrointestinal problems which none the less make slightly strange bedfellows. The inside of the dust jacket, but not the cover, revealed that this was a Paediatric Symposium. This was a relief, as I was about to return it to the editor. Of the 168 pages devoted to review articles on inflammatory bowel disease (IBD), only 10 are dedicated to children. There is only one chapter on abdominal pain devoted to surgical aspects, followed by 27 poster abstracts on paediatric IBD and abdominal pain.

The first chapter is by Wakefield of the Royal Free Group, expanding on the popular and still controversial theme of measles and IBD. The symposium occurred in March 1996 and inevitably we miss out on his latest proposed links with autism and non-specific ileocolitis. A further hypothesis is proposed by Okabe, based on impaired natural killing and antibody dependent cell mediated cytotoxicity, with viruses, again, as a possible target. The second chapter (Brandtzaeg, Haraldsen, and Rugtveit) presents a more conventional hypothesis based on failure of immune exclusion. Amongst the inevitable plethora of abbreviations there are gems such as the use of interleukin 10 enemata in IBD. Wallace and Bell suggest an alternative method of controlling inflammation by preventing white cells from adhering to the endothelium.

A chapter by Fujihashi and 13 others on mucosal immunity is of greater interest to vaccinologists rather than to gastroenterologists. The following chapter by Hollander and only five others covers the fascinating area of animals that lack specific cytokines and that develop chronic IBD but only in the presence of gut flora. An impressively fruitful area for research and potential interventions.

In the first chapter of the clinical section, Seidman and Deslandres have written a salutary chapter highlighting the most of the mistakes that I have made in the management of paediatric IBD. It should be required reading for paediatric gastroenterologists.

In the treatment section, Behrens points out that there have been no randomised, controlled clinical trials of 5-amino salicylic or sulphasalazine in children. The same applies to slow release budesonide, reviewed by Scholmerich. This section concludes with two chapters by Hadziselimovic and Emmons, and Sumer on interferon α as therapy and all give it a warm welcome.

Finally, the surgical contribution by Herzog on chronic abdominal pain in children is inherently interesting, but it avoids the 95% of children in whom abdominal pain has no cause.

Of the 27 abstracts (one in German) Helicobacter pylori was a popular subject. Of seven abstracts, four related to abdominal pain. There were richer pickings for abdominal pain in 10 abstracts in this section.

Hence abdominal pain has been short changed compared with IBD in this volume, reflecting the research activity, relative severity but not the frequency of the two conditions. In retrospect, it might have been more sensible to concentrate on paediatric IBD. Because of this bias, and the excellent chapters on IBD, this volume would appeal to gastroenterologists of the adult type. Let’s hope that the price comes down when we move to a single currency.

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