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Clinician's Manual on Management Issues in Gastro-esophageal Reflux Disease

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Clinician's Manual on Management Issues in Gastro-esophageal Reflux Disease. Edited by JJ Misiewicz (Pp 66; illustrated; £11.95) UK: Science Press. ISBN 1-85873-353-7.

I started reading this book not entirely sure whose bookshelf it was designed to be placed on. It is written largely by mainland European gastroenterologists, with one American contribution, and most contributors will be unfamiliar to British readers. The first chapter gets off to an inauspicious start, being in a very stilted language style and giving a rather simplistic overview. The use of various reflux terms is not clear and there seems a surprising statement about the lack of utility of 24 hour pH studies in endoscopy negative reflux patients. In addition, no mention is made of the Dentsleeve catheter in the manometry section, which is an oversight in view of the fact they are discussing LOS relaxation. Thankfully the content and presentation improve dramatically after chapter 1, giving a very useful and informative book on the subject which can be appreciated at all levels of medical training. Specialist registrars will probably find it most helpful as consultants may wish for something a bit more “meaty”.

There is a clear concise chapter on short term management, with useful supplementary information and good references, but I detect a slight commercial bias with the PPI recommendations, which is unfortunate as this is clearly a sponsored publication. Long term management is up to date, with even a discussion on the recent conflicting views onHelicobacter pylori and proton pump inhibitors, coming down, rightly in my view, on the side of non-eradication. There is a useful summary of the Genval workshop with two clear flowcharts and some specific recommendations on treatment strategies and dosages, which I found particularly helpful. Interestingly, in the “Special management problems” chapter, a different author gives a completely different viewpoint on theHelicobacter pylori/proton pump inhibitor debate, which adds a bit of spice. There is a sensible summary of non-cardiac chest pain and clear guidelines on drug treatment of reflux disease in pregnancy. Within the confines of a very short chapter, Barrett's is sensitively handled, as well as other complications of reflux disease, and in the final chapter the indications for surgery are discussed. There follows a description of surgical techniques, including laparoscopic fundoplication, and a detailed analysis of short and long term complications. Overall, this book packs a fair amount into its diminutive size and is sensibly priced. It deserves to be widely read.