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Handbook of Gastroenterology

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Handbook of Gastroenterology. Edited by Yamada T, Alpers DH, Owyang C,et al. (Pp 726; $47.00/£29.38.) Philadelphia: Lippincott-Raven, 1998. ISBN 0-397- 51427-1.

I cannot think of anything more likely to produce dyspepsia in a editor than trying to produce a gastroenterology handbook “particularly suited to medical students, house officers and advanced trainees”. This large group are not known for buying textbooks unless highly relevant to their specific and disparate training needs. However, this is the wide audience that the editor of the phenomenally successful two-volume Textbook of Gastroenterology has targeted. Weighing in at over 800 grammes it is six times heavier than my stethoscope and so can only be used as a portable handbook on the wards for the more athletic trainee. It comprises 76 chapters encompassing the whole of gastroenterology and hepatology. There are thus approximately 10 pages per subject, each in fairly small print with extensive lists (one has 70 items and covers two pages) and algorithms, although no radiological or histological photographs. The index is comprehensive but having found your subject you need prior knowledge to be able to prioritise the somewhat indigestible information. This limits its use for the average UK undergraduate, who after briefly reading the list of causes of diarrhoea could easily volunteer “saline laxatives” as the commonest. The absence of any attempt to give SI unit equivalents for creatinine or bilirubin may be understandable in an American textbook, but limits its use in an acute setting for less experienced trainees. Thus the English name for acetaminophen is not only not indexed but the criteria for referral for liver transplantation in overdose are in units unfamiliar to many UK trainees. Similarly, the list of investigations in the algorithms reads like a script from“er”, although abbreviations are explained in the footnotes. Of course, it is quite possible that I am the only person in the medical register who did not know what “CBC” stands for. Other minor irritants include some surprising but infrequent errors and omissions. For example, the calculation of the serum/ascites albumin gradient in the diagnosis of portal hypertensive ascites is incorrect and no specific mention of thiamine supplementation is given in the paragraph on hyperemesis gravidarum.

So, do I think this book is suitable for the wide audience targeted? For the majority of averagely gastroenterologically minded undergraduates I feel the text is rather submerged in detail. It is certainly much more likely to appeal to postgraduate trainees. Many gastroenterology registrars who tend to skim read might prefer a lighter book with prioritised bullet points rather than continuous prose for use on the wards, and save up for a two volume textbook for reference. However, I have grown to like this much less expensive book of sound bites in gastroenterology and I think it has a useful place in a Calman trainee’s home library. The chapters themselves contain a considerable amount of information and are generally readable, with many sections such as those on inflammatory bowel disease and irritable bowel syndrome being excellent synopses. Another big advantage in this first edition of a multi-author book is that although some overlap between chapters might be expected this has been avoided very well.

For a motivated specialist registrar it would be a fairly painless and constructive exercise to work through one chapter a night - or while commuting - for three months, with weekends off. This approach would be most profitable to those starting a registrar training programme who may feel initially overwhelmed by the amount of information they are expected to acquire. For more senior trainees or consultants, it is useful to have a book that provides a quick summary of those areas that you personally feel are your weaker ones. It is also small enough to hide in your desk draw should you feel embarrassed using a single volume reference book.