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Dyspepsia: The Clinical Consequences.

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Dyspepsia: The Clinical Consequences. Edited by V Heatley, P Moncur (£69.50). UK: Blackwell Science, 2000. ISBN 0-632-05458-1.

Dyspepsia is like pornography—everyone thinks they know what it is but no one can agree on a definition. This is where the analogy ends, however, as there are plenty of books on pornography but few have been written on dyspepsia compared with other areas of gastroenterology. Out of idle curiosity I searched the Internet for books on irritable bowel syndrome and found 25 published in the past five years compared with only three titles specifically on dyspepsia. This is surprising given that dyspepsia represents 50% of a gastroenterologist's workload and it is refreshing to see an up to date book on the subject.

The book discusses the epidemiology, pathophysiology, diagnosis, and treatment of dyspepsia in a methodical fashion. There are contributions from an illustrious list of authors many of whom have international reputations in the field of dyspepsia research. Each chapter acts as a well informed review on a particular aspect of dyspepsia. The editors and contributors are to be congratulated on ensuring each piece is authoritative yet relatively short and accessible. This approach means that the reader can dip into a chapter most relevant to them and receive up to date information on that topic.

If you read the book from cover to cover however the introductions to each chapter become somewhat repetitive. I became a little tired of hearing about the clinical importance of dyspepsia. There is a chapter on the definition of dyspepsia and yet five other chapters also define the condition. This can be confusing as some characterise dyspepsia as any symptom referable to the upper gastrointestinal tract whereas others take the more restrictive Rome II definition. The editors have taken a very broad definition of dyspepsia and have included chapters on gastro-oesophageal reflux disease. This will probably irritate some experts who believe reflux disease should be excluded. However, there is no diagnostic test for dyspepsia and therefore attempts at defining it become reminiscent of theological arguments about how many angels will fit on the point of a needle.

Another minor quibble is that there were only two chapters explicitly discussing Helicobacter pylori and dyspepsia. I realise that H pylori is only one of many causes of dyspepsia but given that this is one of the major discoveries in medicine over the past 20 years, more information on the organism might have been appropriate.

A more major criticism is that the book does not have a chapter that specifically discusses the management of dyspepsia. This is touched on in a few chapters but there are no firm conclusions reached and recent important trials in this area are not fully discussed. This book may therefore disappoint clinicians wanting a more didactic text on the evidence for the management of dyspepsia.

I would warmly recommend this book to all gastroenterologists with an interest in dyspepsia. This is a rapidly changing field which hopefully will be reflected in new editions of this work.