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Diseases of the Gastroesophageal Mucosa. The Acid-Related Disorders
  1. M Lancaster-Smith

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This appears to be the first volume of a planned series entitled Clinical Gastroenterology, intended mainly for clinically orientated gastroenterologists aiming to keep their noses ahead of the field without going into full training. The editor is James Freston and those who have been involved with him in workshops and symposia will not be surprised by the precision and clarity he has drawn from his authors. This is an important feature because despite being a relatively small volume of approximately 70 000 words, it manages to comprehensively cover all aspects of peptic ulcer disease, functional and undiagnosed dyspepsia, and gastro-oesophageal reflux.

The 18 contributors are established experts based in the USA. With the promotion of managed health care in that country it is unsurprising that their discussions encompass not only the clinical but also the cost effectiveness of diagnostic and therapeutic policies. Each chapter is fully referenced, not only from the usual gastroenterology journals, but also from texts unlikely to be on the reading list of the average UK practitioner.

The chapters covering gastro-oesophageal reflux disease (GORD) emphasise the multifactorial nature of the disease and include an evidence based review of the role of lifestyle factors and an analysis of step-up versus step-down therapy. Barrett's oesophagus, an area of continuing confusion, is dealt with succinctly. Nevertheless, sufficient evidence is quoted to tempt even the most sceptical reader to at least consider the possible benefits of surveillance programmes.

Although most UK gastroenterologists accept that non-cardiac chest pain is often of oesophageal origin, they would be less certain about the role of GORD in laryngeal symptoms, asthma, or chronic cough. Pandolfino and Kahrilas provide persuasive evidence to support these concepts but there will be general relief that a three month therapeutic trial of a proton pump inhibitor is the favoured initial approach to management, and that pH and manometric studies should be reserved for resistant cases or prior to referral for fundoplication.

Management protocols are increasingly demanded and those looking for a resource to devise acute non-variceal bleeding guidelines will welcome Machicado and Jensen's chapter. The clinical, laboratory, and endoscopic risk factors for rebleeding and death are delineated and selection criteria for endoscopic intervention are substantiated.

The retention of the confusing term “non-ulcer dyspepsia” rather than “functional dyspepsia” is a minor irritation. Nevertheless, the chapter covering this nebulous topic appropriately reviews current opinion and concludes that Helicobacter pylori and gastric acid have little to do with endoscopically negative belly ache.

For those who, like your reviewer, need to update their lectures, this book will be an invaluable aid. If subsequent volumes are of comparable quality the series deserves to find a place on the shelves of UK gastroenterology departments, although the price of $99 for a 200 page volume may discourage its purchase.


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