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The Helicobacter pylori
  1. G D BELL

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TheHelicobacter pylori Handbook, 2nd edn. RV Heatley (Pp 64; illustrated; £12.95). UK: Blackwell Science Ltd, 1998. ISBN 0-632-05176-0.

In his preface, Dr Heatley states “Having been involved in the production of one of the established texts on this subject, and also having contributed to others, I have written this book with the generalist in mind. It is intended mainly for those in primary care but, hopefully will also be of value to many in other disciplines including hospital specialities not principally involved withH pylori management, including those in care of the elderly patients, paediatrics, general bacteriology, chemical pathology, nuclear medicine and pharmacy, as well as others.” To what extent do I think Dr Heatley has succeeded in his aims in producing a book suitable for general practitioners and other non-gastroenterologists?

This is actually the second edition of a book originally published in 1995 and has been extensively updated. The book is only 64 pages in length with some 22 figures and 24 tables. It is divided into four chapters entitled: (1) Helicobacter pylorithe organism; (2) Helicobacter pylori: the clinical problem: (3) Management of Helicobacter pylori infection, and (4) Managing dyspeptic conditions in theH pylori era. Considering the fact that thousands of original papers have been written in the 16 or so years since Barry Marshall and colleagues first “discovered” the bacteria, I think the author has summarised the relevant literature very well indeed. However, there are no references or lists of suggested reading, and I think this is a weakness.

I thought the first three chapters were excellent but was frankly a bit disappointed with the fourth and final chapter dealing with the management of dyspeptic conditions. In this era of “evidence based medicine” perhaps the author is correct to be so critical of, for example, the evidence that Helicobacter pylori is indeed a class I carcinogen, as suggested by the WHO or the Maastricht Consensus report's recommendations on the management of Helicobacter pylori positive NUD. However, in the real world most NUD patients if told they have a bug in their stomach which if left might have a 1:4 chance of later causing a peptic ulcer or a 1:100 chance of turning into stomach cancer, will opt for eradication therapy. Textbooks in such a fast moving field asHelicobacter pylori are in danger of being out of date almost as soon as they are published. Perhaps a short term compromise would be for the interested general practitioner to first read Dr Heatley's little book to “get up to speed” on the subject and then look at the relevant clinical sections of the excellent supplement of Gut reporting on the 5th Education Training Workshop in Helicobacter pylori held in Bologna in 1998. They would find NJ Talley's article entitled “How should Helicobacter pylori positive dyspeptic patients be managed?” particularly useful to balance out the rather negative views expressed by Dr Heatley in his book.