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Current therapy in gastroenterology and liver disease 1984–1985
GASTROENTEROLOGY 1986;90:249-54
BOOK
REVIEWS
Armand Littman, M.D. Book Review Editor Veterans Administration Hines, Illinois 60141
Hospital
Bockus Gastroenterology. Fourth ed. By J. E. Berk, Editorin-Chief, and W. S. Haubrich, M. H. Kalser, J. L. A. Roth, and F. Schaffner, Associate Editors. Seven volumes, 5408 pp., 2495 figures, $495.00 per set, $80.00 per volume. W. B. Saunders Co., Philadelphia, Pennsylvania, 1985. For 40 years every gastroenterologically literate person has referred to the definitive English-language treatise on digestive diseases as “Bockus,” e.g., “You’ll find it in Bockus.” For many of us it was a prized acquisition in 1946, when the complete three-volume first edition became available. There were 2897 pages [including the indices) measuring 6 x 9: inches and 427 figures. One or more of the 125 chapters were contributed by 14 members of the staff of the University of Pennsylvania Graduate School of Medicine. Progress in gastroenterology was more leisurely in those days; the final volume of the second edition, also in three volumes, did not emerge until 17 years later in 1963. The page size was increased to 7 X 10 inches, the number of chapters to 143, the number of pages to 3551, and the number of contributors to 31, all current or former Bockus trainees or collaborators. Thereafter, the pace of new developments in the specialty quickened; the third edition comprising four volumes was completed 11 years later in 1974. There was a further increase in the page size to 7: x 14 inches, in the number of chapters to 185, in the number of pages to 4325 (including the indices), and in the number of contributors to 53, many of whom were not Bockus alumni. For this edition of Bockus, Berk was listed as editor, and Haubrich, Kalser, Roth, and Vilardell as associate editors. The present edition, coming none too soon in view of the tremendous advances in diagnosis and treatment in the intervening years, is a seven volume tour de force, a monumental achievement by Berk, his associate editors, and the publishers. At the end of each volume is a complete index to all seven volumes, and in the lower right corner of each page of the index is a guide to the volumes in which the pages cited can be found. The material is as current as possible in a work of this magnitude; the bibliographies contain occasional references published in 1983 and 1984. As for the reliability of the information, it is sufficient to note that the contributors are internationally recognized authorities, assisted in a number of chapters by their trainees. The all-encompassing scope of this work is illustrated by the subject headings and subheadings of the respective volumes (given below). 1.
Clinical approach to the patient. Diagnostic procedures. Here we find chapters on interpretation of symptoms, new imaging techniques, and endoscopy. A regrettable omission is Chapter 1 of the previous edition, Walter Palmer’s “The beginnings of modern
2.
3.
4.
5. 6. 7.
gastroenterology with special reference to the United States of America.” Esophagus, stomach, duodenum. This is the first of five volumes devoted to diseases of the digestive organ systems. Each section begins, where relevant, with applied anatomy and physiology. One of the most gratifying features of this volume is Morrissey’s statement that not all patients with gastric ulcers need to be endoscoped. Intestine, part 1. Small intestine; vascular disorders; specific infectious diseases. The outstandinG contribution to this volume is Hammond and Littman’s classic chapter on disaccharide malabsorption. Intestine, part 2. Chronic inflammatory bowel disease; colon. Turn to this volume for a superb monograph on Crohn’s disease. Liver. This volume is edited by Fenton Schaffner. No more need be said. Biliary tract and pancreas. Peritoneum; parasites; nutrition; relationships with other systems; cancer.
The coverage is obviously panoramic. Not every gastfoenterologist will agree with everything written here; indeed, there are even disagreements among contributors. For example, in volume 1, Cohen makes the clinically practical statement that in a patient with heartburn, further diagnostic study is not necessary unless the patient fails to respond to medical therapy. However, in voldme 2, Roth outlines a medical regimen that is to be institbted only after the diagnosis of reflux esophagitis is confirm’ed by a series of diagnostic interventions. A chapter-andverse critique would take up an entire issue of this journal and it would not alter the fact that Berk’s Bockus is a magnificent achievement. It belongs in every medical library, of course; but it is also indispensable to the personal library of every gastroenterologist, general internist, and general surgeon. WILLIAM H. BACHRACH,M.D.,Ph.D. Rockville, Maryland
Current Therapy in Gastroenterology and Liver Disease 1984-1985. Edited by T. M. Bayless. 517 pp., $58.00. B. C. Becker Inc., Philadelphia, Pennsylvania, 1984. Are you faced for the first time in a while with managing a patient with chronic intestinal pseudoobstruction or Crohn’s disease with growth retardation? Are you trying to provide nonsurgical management for a patient with obstructing carcinoma of the esophagus or biliary tract? Do you feel somewhat behind the times with respect to trendy or topical diseases and issues such as the “gay bowel,” bulimia, and fad diets? Have you been asked to recom-
250 BOOK REVIEWS
mend therapy for a patient with an immunodeficiency state and a gastrointestinal problem or a child with peptic ulcer disease? Would you like to know how sclerotherapy of varices is performed in one of the world’s busiest liver centers? If so, you can obtain the information in the usual ways, such as consulting textbooks, reviewing the literature, attending meetings, or asking colleagues. But these require time and access, two commodities you probably have little of as you struggle to keep abreast of managing your patients with gastroesophageal reflux, chronic inflammatory bowel disease, and irritable bowels, just to mention a few of the major categories. Another approach, not mutually exclusive of the others, is to consult this book. You will find 103 topics covered by experts who treat the diseases and conditions they discuss. The management of every significant gastrointestinal and hepatobiliary condition is discussed in sufficient detail to permit the reader to apply the information quickly to the care of patients. Medical and surgical approaches are discussed. A remarkable amount of practical information is supplied. A few of the many examples include the relative cost of nutritional support regimens, names and addresses of suppliers of gluten-free products, reference materials for patients with sprue, and how to guide alcoholic patients through the proliferating treatment programs. “Tricks of the trade” abound and attest to the hands-on experience of the authors. The practical points are not provided at the expense of more sophisticated information, such as the comparative value of drugs for various conditions and what to expect from your treatment. How is it possible to provide both practical and more esoteric information about so many conditions in a volume that is 1 inch thick and set in print of ordinary size? The answer lies in key editorial decisions and style. Diagnosis and pathophysiology have been deemphasized or omitted. It is assumed that the reader will have a diagnosis before consulting this book. Space is saved by the liberal use of tables and by providing few references. Little attention is paid to traditional pharmacologic considerations like bioavailability, pharmacokinetics, and drug metabolism and excretion. The style is a combination of informed opinion and documentation by references to key studies in the text. This also saves space while leaving the reader with a clear understanding of how an expert manages the condition and, to a lesser but not troublesome extent, why he or she does it that way. Another expert might quibble about certain details or make the point in another way, but this should be of little concern to the users of the book. The intended audience is the experienced practitioner who is familiar with digestive diseases. This seems about right, but some not-so-experienced clinicians, such as gastrointestinal fellows, will also find it useful. A new book doesn’t often fit a need as closely as this one does. Its value exceeds its cost by a considerable margin. JAMES W. FRESTON,
M.D.,Ph.D. Farmihgton, Connecticut
Pathology of the Esophhgus and Duodenum. Volume 4 of Series “Contemporary Issues in Surgical Pathology.” Ed-
GASTROENTEROLOGY
Vol. 90, No.
ited by H. Appelman. 296 pp., $49.50. Churchill stone, New York, New York, 1984.
1
Living-
Appelman says in his preface that this book does not attempt to be encyclopedic, but that it does cover the common and many uncommon upper gastrointestinal lesions, along with some “trendy” disorders such as endocrine tumors. His assessment is valid. Each of the eight chapters by seven pathologists gives a detailed overview of the pathology in the author’s assigned area, along with discussions of more unusual aspects that are his special province. The monograph complements an earlier volume on the mid and lower gastrointestinal tract [Pathology of the Colon, Small Intestine and Anus, edited by H.T. Norris, Volume 2 of the series “Contemporary Issues in Surgical Pathology”), so that the two together provide reasonably complete and current coverage of gastrointestinal pathology. Appelman has written a chapter on “Localized and extensive expansions of the gastric mucosa,” turning a confusing area of gastric pathology into a well-organized presentation that is marked by clear definitions and descriptions of what is known and not known about gastric polyps and mucosal hyperplasias. That chapter is virtually worth the price of the book. Appelman’s section on stromal tumors is also,notably clear and well organized. A chapter on inflammatory and neoplastic diseases of the esophagus by Frank Mitros is a balanced, sensible discussion of the pitfalls one encounters when interpreting lower esophageal biopsy in gastroesophageal reflux. Coverage of gastric carcinomas by Donald Antonioli is well organized and well written, although, surprisingly, his section on carcinoma of the cardia makes no mention of overlap with carcinoma arising in Barrett’s esophagus. Ali H. Qizilbash gives a good compendium of the mostly uncommon duodenal and periampullary epithelial neoplasms. There are also useful summations of endocrine pathology by Juan Lechago and of lymphoproliferative lesions, including the difficult area of gastric pseudolymphoma, by Charles E. Platz. The various forms of gastritis and duodenitis are covered by David Owen, in most cases appropriately. But I was disappointed in the author’s approach to ordinary chronic gastritis. Owen begins with the statement that “chronic gastritis is really a single disease.” All such conditions are then lumped together pathologically as rather than by considering purely inflam“nonspecific,” matory gastritis as usefully separable into forms that are distinctive in regard to features such as distribution and intestinal metaplasia. Alterations to the stomach after subtotal gastrectomy are not even mentioned. Epidemiologic, clinical, pathogenetic, and etiologic aspects of ordinary gastritis are discussed in a different part of the chapter, thereby implying to the reader that these aspects are not especially relevant to pathologic assessment. On the contrary, pathologists should be striving to pull together all available information about patients with chronic gastritis. They should not deal with gastritis as though it is a single entity-a condition that an overwhelming amount of evidence tells us it is not. There is no better proof of the need to assess gastritis carefully and
BOOK
REVIEWS
Armand Littman, M.D. Book Review Editor Veterans Administration Hines, Illinois 60141
Hospital
Bockus Gastroenterology. Fourth ed. By J. E. Berk, Editorin-Chief, and W. S. Haubrich, M. H. Kalser, J. L. A. Roth, and F. Schaffner, Associate Editors. Seven volumes, 5408 pp., 2495 figures, $495.00 per set, $80.00 per volume. W. B. Saunders Co., Philadelphia, Pennsylvania, 1985. For 40 years every gastroenterologically literate person has referred to the definitive English-language treatise on digestive diseases as “Bockus,” e.g., “You’ll find it in Bockus.” For many of us it was a prized acquisition in 1946, when the complete three-volume first edition became available. There were 2897 pages [including the indices) measuring 6 x 9: inches and 427 figures. One or more of the 125 chapters were contributed by 14 members of the staff of the University of Pennsylvania Graduate School of Medicine. Progress in gastroenterology was more leisurely in those days; the final volume of the second edition, also in three volumes, did not emerge until 17 years later in 1963. The page size was increased to 7 X 10 inches, the number of chapters to 143, the number of pages to 3551, and the number of contributors to 31, all current or former Bockus trainees or collaborators. Thereafter, the pace of new developments in the specialty quickened; the third edition comprising four volumes was completed 11 years later in 1974. There was a further increase in the page size to 7: x 14 inches, in the number of chapters to 185, in the number of pages to 4325 (including the indices), and in the number of contributors to 53, many of whom were not Bockus alumni. For this edition of Bockus, Berk was listed as editor, and Haubrich, Kalser, Roth, and Vilardell as associate editors. The present edition, coming none too soon in view of the tremendous advances in diagnosis and treatment in the intervening years, is a seven volume tour de force, a monumental achievement by Berk, his associate editors, and the publishers. At the end of each volume is a complete index to all seven volumes, and in the lower right corner of each page of the index is a guide to the volumes in which the pages cited can be found. The material is as current as possible in a work of this magnitude; the bibliographies contain occasional references published in 1983 and 1984. As for the reliability of the information, it is sufficient to note that the contributors are internationally recognized authorities, assisted in a number of chapters by their trainees. The all-encompassing scope of this work is illustrated by the subject headings and subheadings of the respective volumes (given below). 1.
Clinical approach to the patient. Diagnostic procedures. Here we find chapters on interpretation of symptoms, new imaging techniques, and endoscopy. A regrettable omission is Chapter 1 of the previous edition, Walter Palmer’s “The beginnings of modern
2.
3.
4.
5. 6. 7.
gastroenterology with special reference to the United States of America.” Esophagus, stomach, duodenum. This is the first of five volumes devoted to diseases of the digestive organ systems. Each section begins, where relevant, with applied anatomy and physiology. One of the most gratifying features of this volume is Morrissey’s statement that not all patients with gastric ulcers need to be endoscoped. Intestine, part 1. Small intestine; vascular disorders; specific infectious diseases. The outstandinG contribution to this volume is Hammond and Littman’s classic chapter on disaccharide malabsorption. Intestine, part 2. Chronic inflammatory bowel disease; colon. Turn to this volume for a superb monograph on Crohn’s disease. Liver. This volume is edited by Fenton Schaffner. No more need be said. Biliary tract and pancreas. Peritoneum; parasites; nutrition; relationships with other systems; cancer.
The coverage is obviously panoramic. Not every gastfoenterologist will agree with everything written here; indeed, there are even disagreements among contributors. For example, in volume 1, Cohen makes the clinically practical statement that in a patient with heartburn, further diagnostic study is not necessary unless the patient fails to respond to medical therapy. However, in voldme 2, Roth outlines a medical regimen that is to be institbted only after the diagnosis of reflux esophagitis is confirm’ed by a series of diagnostic interventions. A chapter-andverse critique would take up an entire issue of this journal and it would not alter the fact that Berk’s Bockus is a magnificent achievement. It belongs in every medical library, of course; but it is also indispensable to the personal library of every gastroenterologist, general internist, and general surgeon. WILLIAM H. BACHRACH,M.D.,Ph.D. Rockville, Maryland
Current Therapy in Gastroenterology and Liver Disease 1984-1985. Edited by T. M. Bayless. 517 pp., $58.00. B. C. Becker Inc., Philadelphia, Pennsylvania, 1984. Are you faced for the first time in a while with managing a patient with chronic intestinal pseudoobstruction or Crohn’s disease with growth retardation? Are you trying to provide nonsurgical management for a patient with obstructing carcinoma of the esophagus or biliary tract? Do you feel somewhat behind the times with respect to trendy or topical diseases and issues such as the “gay bowel,” bulimia, and fad diets? Have you been asked to recom-
250 BOOK REVIEWS
mend therapy for a patient with an immunodeficiency state and a gastrointestinal problem or a child with peptic ulcer disease? Would you like to know how sclerotherapy of varices is performed in one of the world’s busiest liver centers? If so, you can obtain the information in the usual ways, such as consulting textbooks, reviewing the literature, attending meetings, or asking colleagues. But these require time and access, two commodities you probably have little of as you struggle to keep abreast of managing your patients with gastroesophageal reflux, chronic inflammatory bowel disease, and irritable bowels, just to mention a few of the major categories. Another approach, not mutually exclusive of the others, is to consult this book. You will find 103 topics covered by experts who treat the diseases and conditions they discuss. The management of every significant gastrointestinal and hepatobiliary condition is discussed in sufficient detail to permit the reader to apply the information quickly to the care of patients. Medical and surgical approaches are discussed. A remarkable amount of practical information is supplied. A few of the many examples include the relative cost of nutritional support regimens, names and addresses of suppliers of gluten-free products, reference materials for patients with sprue, and how to guide alcoholic patients through the proliferating treatment programs. “Tricks of the trade” abound and attest to the hands-on experience of the authors. The practical points are not provided at the expense of more sophisticated information, such as the comparative value of drugs for various conditions and what to expect from your treatment. How is it possible to provide both practical and more esoteric information about so many conditions in a volume that is 1 inch thick and set in print of ordinary size? The answer lies in key editorial decisions and style. Diagnosis and pathophysiology have been deemphasized or omitted. It is assumed that the reader will have a diagnosis before consulting this book. Space is saved by the liberal use of tables and by providing few references. Little attention is paid to traditional pharmacologic considerations like bioavailability, pharmacokinetics, and drug metabolism and excretion. The style is a combination of informed opinion and documentation by references to key studies in the text. This also saves space while leaving the reader with a clear understanding of how an expert manages the condition and, to a lesser but not troublesome extent, why he or she does it that way. Another expert might quibble about certain details or make the point in another way, but this should be of little concern to the users of the book. The intended audience is the experienced practitioner who is familiar with digestive diseases. This seems about right, but some not-so-experienced clinicians, such as gastrointestinal fellows, will also find it useful. A new book doesn’t often fit a need as closely as this one does. Its value exceeds its cost by a considerable margin. JAMES W. FRESTON,
M.D.,Ph.D. Farmihgton, Connecticut
Pathology of the Esophhgus and Duodenum. Volume 4 of Series “Contemporary Issues in Surgical Pathology.” Ed-
GASTROENTEROLOGY
Vol. 90, No.
ited by H. Appelman. 296 pp., $49.50. Churchill stone, New York, New York, 1984.
1
Living-
Appelman says in his preface that this book does not attempt to be encyclopedic, but that it does cover the common and many uncommon upper gastrointestinal lesions, along with some “trendy” disorders such as endocrine tumors. His assessment is valid. Each of the eight chapters by seven pathologists gives a detailed overview of the pathology in the author’s assigned area, along with discussions of more unusual aspects that are his special province. The monograph complements an earlier volume on the mid and lower gastrointestinal tract [Pathology of the Colon, Small Intestine and Anus, edited by H.T. Norris, Volume 2 of the series “Contemporary Issues in Surgical Pathology”), so that the two together provide reasonably complete and current coverage of gastrointestinal pathology. Appelman has written a chapter on “Localized and extensive expansions of the gastric mucosa,” turning a confusing area of gastric pathology into a well-organized presentation that is marked by clear definitions and descriptions of what is known and not known about gastric polyps and mucosal hyperplasias. That chapter is virtually worth the price of the book. Appelman’s section on stromal tumors is also,notably clear and well organized. A chapter on inflammatory and neoplastic diseases of the esophagus by Frank Mitros is a balanced, sensible discussion of the pitfalls one encounters when interpreting lower esophageal biopsy in gastroesophageal reflux. Coverage of gastric carcinomas by Donald Antonioli is well organized and well written, although, surprisingly, his section on carcinoma of the cardia makes no mention of overlap with carcinoma arising in Barrett’s esophagus. Ali H. Qizilbash gives a good compendium of the mostly uncommon duodenal and periampullary epithelial neoplasms. There are also useful summations of endocrine pathology by Juan Lechago and of lymphoproliferative lesions, including the difficult area of gastric pseudolymphoma, by Charles E. Platz. The various forms of gastritis and duodenitis are covered by David Owen, in most cases appropriately. But I was disappointed in the author’s approach to ordinary chronic gastritis. Owen begins with the statement that “chronic gastritis is really a single disease.” All such conditions are then lumped together pathologically as rather than by considering purely inflam“nonspecific,” matory gastritis as usefully separable into forms that are distinctive in regard to features such as distribution and intestinal metaplasia. Alterations to the stomach after subtotal gastrectomy are not even mentioned. Epidemiologic, clinical, pathogenetic, and etiologic aspects of ordinary gastritis are discussed in a different part of the chapter, thereby implying to the reader that these aspects are not especially relevant to pathologic assessment. On the contrary, pathologists should be striving to pull together all available information about patients with chronic gastritis. They should not deal with gastritis as though it is a single entity-a condition that an overwhelming amount of evidence tells us it is not. There is no better proof of the need to assess gastritis carefully and