Book and Media Reviews Section Editor: John L. Zeller, MD, PhD, Fishbein Fellow. Edited by Mark Feldman, Lawrence S. Friedman, and Lawrence J. Brandt, 8th ed, 3024 pp, $279. Philadelphia, Pa, Saunders Elsevier, 2006. ISBN-13 978-1-4160-0245-1. This text, appearing 4 years after its seventh edition, reflects the major changes that have occurred in genetics, immunology, diagnosis, treatment, evidence-based medicine, and publishing. The addition of a third editor and assistants for images and pathology, the redrawing of nearly all illustrations for uniformity, and an extensive incorporation of new authors /contributors emphasize the changes. Although the overall format is retained, major sections have been completely rewritten, reflecting progress in biology, diagnosis, and treatment. The initial section strikingly illustrates the revisions, with 3 chapters covering gastrointestinal hormones and neurotransmitters, mucosal immunology and inflammation, and cellular growth and neoplasia. Many integrative cartoons delineate newer biological ideas needed to understand later chapters. Later, when each organ is discussed, an introductory chapter expands on the development and common genetic changes, and these chapters have been essentially rewritten from earlier editions. The second section (10 chapters) details a clinical approach to common symptoms and signs. Even with 4 new authors, there has been little change. The third section, on nutrition, has 5 new authors and has been largely refashioned but reflects change in emphasis rather than new information. There is a particularly useful chapter on eating disorders and sensible coverage of food allergies and obesity. With 20 chapters, the fourth section is a catchall for “topics involving multiple organs.” Outstanding and abundant illustrations make the chapters on oral and cutaneous manifestations of gastrointestinal tract disease, diverticula, hernias and gastric volvulus, and abscesses and fistulae very strong. A new chapter on stromal tumors and a revised one on lymphomas are noteworthy. Skipping to the final section, 3 chapters on psychosocial issues admirably present new material. The first approaches the impact of gastrointestinal tract disease on the patient, the second considers palliation, and the third discusses alternative-medicine therapies. Each of these is well done and should be presented earlier in subsequent editions. The major portion of the text addresses the diseases of each of the gastrointestinal tract organs, covering biology, pathobiology, diagnosis, and treatment. I found common afflictions for which large numbers of randomized controlled trials exist to be the best presented, with a good balance of illustrations and evidence-based data. Thus, the chapters on gastroesophageal reflux disease, gastric tumors, hepatitis C, portal hypertension, liver transplantation, and ulcerative colitis are truly outstanding. The remaining chapters are accurate and readily understandable. It is difficult to fault such an excellent resource text, but there are a few areas for improvement. The editors did an excellent job in eliminating redundancy, but the bibliographies need supervision. Several chapters have more than 600 references, and most of the older bibliographic references are adequately covered in preceeding chapters, so contributors should limit themselves to about 200 references. There is a marked increase in illustrations of endoscopic ultrasound, and this keeps pace with the increased merit of this procedure in gastroenterological diagnosis. Endoscopic retrograde cholangiopancreatography continues to be illustrated, but the safer magnetic resonance cholangiopancreatography is hardly illustrated. The well-informed authors occasionally suggest genetic tests or biochemical studies sufficiently uncommon that the reader could be better directed as to how these test results might be obtained. Thus, suggestions of mutation analysis in Wilson disease, gene studies in polyp disease, and enzyme studies during azathioprine therapy need sources or further information to guide the reader. The publishers have now placed the illustrations, including the myriad color photomicrographs and cartoons, on the pages where they are discussed. The size of the illustrations sufficiently highlight the desired point, and the Internet version permits further enlargement or even projection at a conference. The print edition is color coded on the edge to instantly guide the reader to a desired section, or, alternatively, the reader can use the comphrehensive index reproduced in each of the 2 volumes. Each chapter (and the table of contents) is headed by a brief outline facilitating access to a given topic. The text is quite clear and, though heavy to carry, is user-friendly. Overall, the authors and editors have produced an outstanding new edition. The improved illustrations, the ample new material, the avoidance of redundancy, and the incorporation of evidence-based principles make this an essential tool for any medical library. It is clearly the book to go to for up-to-date and authoritative information on gastrointestinal tract and liver conditions. Back to top Article Information Financial Disclosures: None reported.
– American Medical Association
Published: Apr 4, 2007