Clinical Gastroenterology

This text represents the work of a group of clinicians in the fields of adult and pediatric gastroenterology and general and colorectal surgery who have set out to write ". . . a book reviewing the present status of clinical gastroenterology in a practical way, founded on a background of up-to-date physiology, biochemistry, and pathology ... [for] use in approaching the patient with gastroenterologic disease." From the first chapter, cryptically entitled "Sore Mouth-Bad Taste" to the more mundane "Benign and Malignant Tumors of the Liver," the 20 contributors to Clinical Gastroenterology pool their expertise. The first section of the text deals with presenting symptoms and signs, while the final 32 chapters cover more specific organ-related illnesses. On the whole, the numerous chapter authors have achieved an amazing degree of concordance in both style and breadth, and the text reads smoothly. Considerable emphasis is placed on tables both of the inclusive differential diagnosis type (e.g., in sore mouth-bad taste) and of the comparative type (e.g., separation of chronic hepatidities), sure to please both lumpers and splitters. Line drawings and radiographs are excellent and well-labeled, although one could take exception to the repetition of the Whipple procedure diagrammed in both chapters 43 and 44. Summaries of experience with patient groups at both the Cleveland Clinic and elsewhere are presented concurrently, although one gets the impression that the local data are somewhat superior. Reference lists are concise, with what appear to be mostly review articles. Particularly well covered were the medical and surgical managements of inflammatory bowel disease and pancreatic neoplasia. Less attention was devoted to liver disease, with only marginal coverage of hepatitis vaccine, the etiologies of porto-systemic encephalopathy, and newer modalities for treating established cirrhosis. Given the surgical emphasis of other sections, one would have expected at least some discussion of various shunting procedures used in portal hypertension. In general, however, this text accomplishes its purpose well. It would be an excellent addition to any medical generalist's library or as a reference for physicians in training.