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Development of the Gastrointestinal Tract

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Development of the Gastrointestinal Tract. Edited by I R Sanderson, W A Walker (Pp 324; illustrated). Canada: BC Decker Inc, 2000. ISBN 1 55009 081 X.

When I was a fellow with Allan Walker 15 years ago, gut development was a topic of interest to a handful of researchers worldwide. A classic review by Grand, Watkins, and Torti published inGastroenterology in 1976, and Koldovsky's monograph Development of the Functions of the Small Intestine in Mammals and Man in 1969 brought together much of what was then known about the ontogeny of the human gut. Developmental biologists were beginning to recognise the opportunities offered by this rapidly differentiating organ to understand the interactions of genetic endowment and environmental influences in early life. The focus of much research was on the process of adaptation to milk feeding. With the survival of ever more preterm infants, the function of the immature gut and its capacity to deal with enteral feeds prematurely were questions of increasing practical concern.

I had the grand idea at that time to produce a short book bringing the field together. But I quickly realised that not only was it growing too fast but that a full understanding of gut development and function also required an understanding of the composition and properties of human milk and the metabolism of the newborn. The developing gastrointestinal tract and lactating mammary gland are complementary organs, jointly involved in the transfer of nutrients and other substances from mother to infant. Until weaning the neonate is an extra-gestate fetus, and breast and gut are analogous to the uterine-placental interface.

This book goes a long way to recognising this. Each chapter (essentially a stand alone review) is written by a leading figure or group expert in its field. Together they cover the major aspects of gut development and function but apart from a short preface there is no overview or attempt to synthesise the book's contents. It would be impossible for one author to write this book. The impact of molecular biology has moved the subject from an essentially descriptive science, with some experimental work in vivo, to the level of the cell and gene. This has shifted it away from the womb, breast, or incubator and into the laboratory. This book is a valuable starting point for students or researchers wishing to get up to date with the basic biology of human gut development but it will be of little interest to the practising neonatologist struggling to define rational approaches to feeding the preterm neonate.

Medicine is fast becoming a major branch of biology, concerned with the application, often experimentally, of novel therapies based on insights and new understanding of biological processes. However, at a time when the biological sciences are advancing so rapidly, and manipulation of genes within cells, including those of the embryo, is possible, the gap between the worlds of medicine and biology is widening rather than narrowing.

The last century saw the integration of medicine and science, and a determination to base the practice of the former on the latter. At the beginning of this century we are struggling to define a core of knowledge, skills, and ideas to teach our medical students. The wide scope of what we currently regard as the province of medicine now includes sociology, psychology, epidemiology, etc, and the basic sciences have been squeezed. We may be making a mistake in failing to equip medical students and young doctors with a firm understanding of the “new biology”, embracing genetics, molecular medicine, and developmental biology. This book deals with these things, and although its subject is a small part of the totality of human biology, it is dealt with in depth by recognised leaders. Ian Sanderson and Allan Walker must be congratulated for bringing their research together.

Development of the Gastrointestinal Tract is also provided as a CD-ROM but this offers little more than the facility to read it on screen. It has no search tools, nor is it possible to cut and paste sections (for those wishing to produce a review article overnight). However, the opportunity to print out chapters will abolish the tedium of photocopying, and also preserve the spine of this handsome and well produced book.