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Therapy of Digestive Disorders
  1. R N ALLAN

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Therapy of Digestive Disorders. Edited by Wolfe MM, Cohen S, Davis GL,et al. (Pp 881; hardback; illustrated; £85.) Philadelphia: WB Saunders, 1999. ISBN 0 72167 340 6.

This is a substantial book edited by Dr Michael Wolfe with six of his colleagues acting as section editors. Many of the hundred or so contributors are members of the Boston home team. The others are from the key centres in North America with a smattering of contributors from Canada, Europe, Israel, and South America. This is in effect a GI textbook, but stripped largely of pathogenesis, pathophysiology, diagnosis, and differential diagnosis. Five main sections consider treatment of oesophageal, gastroduodenal, pancreatic or biliary, hepatic, and intestinal diseases.

The two column black and white presentation is relieved by good summary tables, with small clear diagrams and figures within the two column format. No flashy colour or bullet points here, but good solid information.

Clear instructions to the contributors and careful editing has produced consistent and well balanced chapters. For example, the excellent contribution from Stephen Hanner deals briefly with an approach to history taking, physical examination, diagnostic studies, and laboratory investigation in patients with inflammatory bowel disease. This is followed by an overview of individual patient management and then the “meat” of the chapter reviews therapeutic options for ulcerative colitis and Crohn's disease. The approaches to treatment in North America and in Europe were remarkably similar. International journals and meetings have narrowed the Atlantic Ocean to a trickle.

The chapter on non-variceal GI bleeding by Lichtenstein also provides remarkably consistent intercontinental advice, which is practical and appropriate and wherever possible evidence based. The detail is remarkable—for example, he has researched the history of iced saline lavage and concludes that water at room temperature is perfectly acceptable!

I particularly liked the section on therapeutic endoscopy, which is a model of clarity and brevity.

Whichever chapter is selected, the information is consistent, reliable, and well researched. The chapter by Nicholas La Russo on primary sclerosing cholangitis opens with an excellent and brief review of the genetics, pathogenesis, clinical features, diagnosis, and natural history, and then considers potential therapy of cupruresis, immunosuppressant agents, antifibrogenesis, cholestatic agents, surgery, and transplantation.

Even in complex areas such as the contribution by John Del Valle, concerned with the treatment of neuro endocrine tumours, for each specific syndrome there is a crisp, clear summary of recommended treatment.

In summary, this is a remarkable, formidable achievement with consistent structure and advice, which is reliable and well based. Inevitably for a book of this size, the turnaround time results in the latest references running back to 1997, so computer based systems will be needed to bring the reader up to date.

What of the next edition? This would be an ideal CD-ROM based book with regular updating. Many of the older references could be stripped out to make way for the new, and if we are still buying textbooks then layout and presentation will need improvement.

If you need a guiding hand and expert advice for the treatment of any digestive disorder, this is the book for you.