The most complete reference work available! This textbook's balanced, yet detailed account of the basic science of the digestive system includes up-to-date discussions of the cell biology and molecular biology which underlie and determine its function. Includes thorough descriptions of organ physiology, as well as the pathophysiology of the signs, symptoms, and laboratory abnormalities of organ disease. For completeness in diagnosis and management, a separate section features problems involving multiple organs, such as AIDS, systemic manifestation of G-I disease, and abdominal pain and bleeding. Also new to this edition is an expanded section devoted to disorders of the liver.
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Mark Feldman, MD, Chair of Internal Medicine, Presbyterian Hospital of Dallas, Clinical Professor of Internal Medicine, University of Texas Southwestern Medical School of Dallas, Dallas, TX; Lawrence S. Friedman, MD, Professor of Medicine, Gastroinstestinal Unit, Massachusetts General Hospital, Boston, MA; and Marvin H. Sleisenger, MD, Distinguished Physician, Department of Veterans Affairs Medical Center, San Francisco, CAFrom The New England Journal of Medicine:
In most North American academic medical centers, the departments of gastroenterology and hepatology coexist in an uneasy relationship somewhat akin to a dysfunctional marriage. In previous editions this voluminous textbook was limited to the subject of gastroenterology, in recognition of the fact that there were, and still are, outstanding reference books on hepatology. With this edition, the editors, in including 361 pages dedicated to liver disease, have tacitly recognized that divorce is not imminent and that much of the care of patients with liver disease is provided by physicians trained primarily as gastroenterologists. The result is a "one-stop shopping" reference book of authoritative information on both gastroenterology and hepatology. There is some emphasis on unusual problems and major recent advances, as befits such a reference book. Carcinoid tumors are given more space than is irritable bowel syndrome, and parasitic infections are given more than carcinoid tumors and irritable bowel combined.
The two volumes are generally well organized and make extensive use of tables, graphs, and algorithms to convey much of the information. The referencing and indexing are better than those of previous editions, and more comprehensive. There are rare references to literature published more recently than 1995, but some almost prophetic cautions are expressed about what is likely to come. The chapter on obesity provides a prescient warning about the lack of approval by the Food and Drug Administration of long-term fenfluramine-phentermine therapy.
The outlines at the beginning of each of the 200 chapters are almost redundant, since there are boldly typed subheadings throughout each (usually short) chapter, and the same information is duplicated in the table of contents, which is reproduced in both volumes. Most of the pathological photomicrographs are of high quality and relevant, but some radiographic reproductions require the eye of faith to see what is purported to be illustrated. There is frequent reference to a companion color atlas that will not be available to many readers. The absence of color photographs of some of the more unusual endoscopic findings is a bit disappointing.
As in any multiauthored textbook, there are some outstanding chapters and a few that are difficult and dry. The discussions of ascites in liver diseases, colonic polyps and the polyposis syndromes, and Helicobacter pylori infection should be read by any author interested in learning how to convey pragmatic information concisely and lucidly. Similar precision is sadly lacking in other areas, most notably in the discussions of the use or misuse of vitamin K in treating coagulopathies in liver disease and the investigational approach to nausea and vomiting. Intestinal electrolyte physiology and pathways in liver biochemistry are difficult topics to present in a way that is interesting and relevant to clinicians, and the authors of the chapters on these subjects did not succeed. Excessive investigation is at times also advised -- does everyone with symptoms of irritable bowel syndrome really need a formal lactose-tolerance test?
There are inevitable gaps and overlaps and a few contradictions. Two chapters provide emphatically opposing statements about the validity of guaiac tests of stool obtained during or after digital rectal examination, both supported by references to current literature. The importance of the findings of physical examinations is not presented in any single chapter. I could not answer my resident's question about the importance of detecting fetor hepaticus by consulting this book, since this condition is not mentioned. Nor will you learn to recognize portal hypertensive colopathy by looking it up here, since its only appearance is in a list in a table.
The preface suggests that the target audience for this book includes general internists, trainees in gastroenterology and surgery, and medical students, as well as gastroenterologists. The size of the book alone, however, makes it likely that the only cover-to-cover readers will be trainees preparing for examinations and reviewers. The rest of us involved in the practice of gastroenterology and hepatology and teachers in these fields would do well to have this standard vade mecum on the shelf to consult when we encounter an unfamiliar, unusual, or difficult clinical problem. Overall, it lives up to its reputation as the dominant textbook of gastroenterology.
Reviewed by C.N. Ghent, M.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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