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Management of Chronic Viral Hepatitis
GASTROENTEROLOGY 2002;123:2154 –2155
PRINT AND MEDIA REVIEWS Ian S. Grimm, M.D. Print and Media Review Editor University of North Carolina at Chapel Hill Division of Digestive Diseases and Nutrition Chapel Hill, North Carolina
Intestinal Failure. Edited by J. Nightingale. 565 pp. $129.00. Greenwich Medical Media, London, England, 2001. ISBN 1-90015-193-6. Web address for ordering: www.greenwichmedical.co.uk Intestinal decompensation and failure is the common endpoint for many varied diseases such as short bowel syndrome, intestinal pseudo-obstruction, and radiation enteritis. To date, one has had to piece together information from a combination of sources including medical journals, medicine and surgical textbooks, and lecture series to understand how to approach, diagnose, and treat patients with intestinal failure. Although intestinal failure patients share some common management goals, the specifics of diagnosis and treatment in individualized patients are often related to the patient’s primary disease process. Nightingale has managed to bring these varied aspects of intestinal failure into a very succinct textbook. This book is geared toward all clinicians who are participating in the care of patients with intestinal failure. It is suitable for internal medicine, surgical, and pediatric clinicians. The book is capable of educating clinicians with minimal clinical experience who are taking care of patients with intestinal failure, and fortifying the education of clinicians with advanced skills in the management of patients with intestinal failure. It clearly reaches its goal of focusing on a very important aspect of medicine that has received limited exposure in the past. It hits the mark of providing a concise reference that can be referred to when questions arise regarding the management of patients with complicated intestinal failure. The historical overview of intestinal failure and the normal anatomy and physiology of small intestine were especially strong. This chapter allowed everyone to understand the basics of intestinal physiology and have a very good understanding of the chronology of events in the understanding and treatment of intestinal failure. The chronic intestinal failure chapters, especially those dealing with intestinal failure in children and small bowel dysfunction, were well written and very focused. The chapter on intestinal adaptation to intestinal failure, specifically with reference to short bowel syndrome, dealt with some very important issues especially within the concept of supporting the patient through an adaptive process. The section on treatment of intestinal failure brought out some other very important issues regarding the use of specialized enteral formulations, and the management of high output jejunostomies, a critical aspect of appropriate attention to patients with intestinal failure. The outcomes of intestinal failure section, specifically chapters pertaining to the quality of life assessment and the patient’s perspective on intestinal failure, allow the
clinician to better understand the potential outcome markers to monitor for in those patients receiving therapy for intestinal failure. Finally, the surgical treatment of intestinal failure provided some new concepts with regard to innovative therapy and detailed the current state of small bowel transplantation, an up and coming therapy for small bowel dysfunction. There appears to be good uniformity within the style of the multiple authors within this book. However, there was great discrepancy with regard to the use of tables, graphs, and photographs. Some of the figures were excellent color photographs, whereas the black and white photographs were somewhat difficult to interpret. Some of the authors were able to use their tables very effectively for further explaining either a difficult topic or one that was voluminous in nature. Other tables were not as helpful because they simply repeated items that had been explained within the text. It is difficult to compare this book to other works, because it is the first within its class with a focus on intestinal failure. Bottom Line: I highly recommend this text book for those who are involved with the care of patients with intestinal failure or for those who want to become more familiar with the terminology, physiology, history, and future of intestinal failure.
MARK H. DeLEGGE, M.D., F.A.C.G., C.N.S.P. Section of Nutrition Digestive Disease Center Medical University of South Carolina Charleston, South Carolina Management of Chronic Viral Hepatitis. Edited by Stuart C. Gordon. 392 pp. $150.00. Marcel Dekker Inc., New York. ISBN 0-8247-0582-3. Web address for ordering: www. dekker.com This book aims to fill a gap in the available literature by providing both a comprehensive summary and a practical approach to the diagnosis and treatment of viral hepatitis. With contributions from distinguished scientists, it extensively covers the hepatitis viruses (HBV, HCV, HBV, and HEV). This will be a useful guide for gastroenterologists, hepatologists, nurse practitioners, and physicians in training. The text is well organized. Separate chapters are devoted to diagnosis, virology, and treatment. The sections pertaining to alternative treatments for HCV, treatment of patients with HCV who have persistently normal ALT levels, and management of interferon nonresponders are extremely useful, and all are well referenced. An algorithm for treatment of hepatitis B provides a concise treatment strategy, though expansion to
December 2002
include treatment approaches to patients with YMDD mutations would have been helpful. Sections on recurrent HBV and HCV after liver transplantation are well written, and include a comprehensive review of the literature on this difficult subject. These chapters should be extremely useful for transplant physicians. All chapters start with 2 or 3 case studies, each with a detailed laboratory evaluation. The cases are representative of commonly encountered patients in the hepatology clinic, and serve as a useful introduction to the subject addressed in that chapter. These well-presented case histories are a major strength of this textbook; they illustrate certain points in a way that no volume of discussion could duplicate. The editor should be commended for taking this case-based approach. However, I wish that each chapter also ended with a further discussion of the case (as in chapter 1), with a rationale for the recommended treatment approach. This would have provided additional guidance to fellows and non-hepatologists, and would have further enabled reader to use the book at the bedside. In addition, an algorithm or a table for different case scenarios regarding HCV also would have been useful. This book covers a major gap in the available literature in that it helps clinicians take a focused and concise bedside approach to viral hepatitis. Although it is well referenced, exhaustive reviews of the literature are avoided, allowing for easy access to information. Every month, a large volume of new information pertaining to HCV and HBV is published. By the time a book such as this one rolls off of the presses, there is often a considerable amount of new knowledge that did not make it into print. This information gap is encountered in every textbook, and this one is no exception. More current information on pegylated interferons in hepatitis B and C infections would have been helpful, for instance, especially since future HCV antiviral treatment is likely to be based primarily on PEG interferons. Yet, this is a minor drawback to an otherwise superbly written text, one that does not significantly limit the usefulness of the book. Bottom Line: A comprehensive review of viral hepatitis that offers an easy reference guide for everyday clinical practice.
SATHEESH NAIR, M.D. Department of Abdominal Organ Transplant Ochsner Clinic New Orleans, Louisiana Pediatric Gastroenterology and Nutrition in Clinical Practice. Edited by Carlos Lifschitz. 869 pp. $195.00. Marcel Dekker, Inc., New York, 2001. ISBN 0-8247-0510-6. Web address for ordering: www.dekker.com. One look at this book is all it takes to realize that Lifshitz’s textbook is something different. Instead of being tall, wide, and relatively flat, like most new medical textbooks, this one is thick and short. Pick it up and it is unusually heavy. Open it to any page, and the density of the small-print text printed on weighty, glossy pages is obvious. Illustrations are spare and
PRINT AND MEDIA REVIEWS
2155
practical. This book is not for casual browsing. It is a serious reference for those who want all the details and need to know them. Look closer, and there is more that is surprising. The table of contents reveals that more than half of all pages are devoted to topics in pediatric nutrition. Nutrition is not neglected in other pediatric gastroenterology references, but this one stresses the role of nutrition in childhood and in pediatric gastrointestinal disease. The amount of space devoted to nutrition allows extensive coverage of such diverse themes as growth factors, protein turnover, and metabolism, as well as more clinical chapters on obesity, eating disorders, failure to thrive, and breast feeding. In his preface to the text, Dr. Lifshitz tells us that his intention is to provide a reference that brings us up to date with the “most relevant new facts in molecular biology and genetics, as well as recently acquired clinical information, in conjunction with a practical approach to pediatric gastroenterology and nutrition.” The book’s title suggests that it is a clinical reference, but it is really intended to be much more. The list of authors is a roll call of distinguished multinational experts in nutrition and clinical gastroenterology. Together they have written an amazing array of chapters, some of which are very clinical and practical in nature, such as the chapter on “Feeding patients with acute diarrhea” to much more technical reviews of basic science, such as “New knowledge about protein,” which covers everything from RNA to ubiquitin. The chapters devoted to purely gastrointestinal disease, located in the last half of the text, provide the essential information about these topics. It is in this part of the book that the most practical clinical information may be found. The degree of compression required to cover each chapter in the limited space varies considerably, but generally works well. The best example is the chapter on liver disease, which successfully covers the meaty parts of a huge topic in only 50 pages. Some other clinical topics suffer from space limitations. One example is the chapter on peptic disease, which extensively covers the various etiologies of gastritis, but does not directly address more practical aspects of diagnosis and treatment. In most ways, the stated ambitions of the editor have been achieved. This is not a quick handbook for medical students to use during their third-year clerkships. It offers more, and in some cases, less than most primary care physicians are looking for. However, those who need a review of basic clinical principles can find what they are looking for in the final chapters. The intended audience of this book, including gastroenterologists, gastroenterology fellows, and readers who seek to deepen their understanding of nutrition in health and disease, will not be disappointed. Bottom Line: This book is a valuable resource and a real bargain.
WARREN P. BISHOP, M.D. Department of Pediatrics Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City, Iowa
PRINT AND MEDIA REVIEWS Ian S. Grimm, M.D. Print and Media Review Editor University of North Carolina at Chapel Hill Division of Digestive Diseases and Nutrition Chapel Hill, North Carolina
Intestinal Failure. Edited by J. Nightingale. 565 pp. $129.00. Greenwich Medical Media, London, England, 2001. ISBN 1-90015-193-6. Web address for ordering: www.greenwichmedical.co.uk Intestinal decompensation and failure is the common endpoint for many varied diseases such as short bowel syndrome, intestinal pseudo-obstruction, and radiation enteritis. To date, one has had to piece together information from a combination of sources including medical journals, medicine and surgical textbooks, and lecture series to understand how to approach, diagnose, and treat patients with intestinal failure. Although intestinal failure patients share some common management goals, the specifics of diagnosis and treatment in individualized patients are often related to the patient’s primary disease process. Nightingale has managed to bring these varied aspects of intestinal failure into a very succinct textbook. This book is geared toward all clinicians who are participating in the care of patients with intestinal failure. It is suitable for internal medicine, surgical, and pediatric clinicians. The book is capable of educating clinicians with minimal clinical experience who are taking care of patients with intestinal failure, and fortifying the education of clinicians with advanced skills in the management of patients with intestinal failure. It clearly reaches its goal of focusing on a very important aspect of medicine that has received limited exposure in the past. It hits the mark of providing a concise reference that can be referred to when questions arise regarding the management of patients with complicated intestinal failure. The historical overview of intestinal failure and the normal anatomy and physiology of small intestine were especially strong. This chapter allowed everyone to understand the basics of intestinal physiology and have a very good understanding of the chronology of events in the understanding and treatment of intestinal failure. The chronic intestinal failure chapters, especially those dealing with intestinal failure in children and small bowel dysfunction, were well written and very focused. The chapter on intestinal adaptation to intestinal failure, specifically with reference to short bowel syndrome, dealt with some very important issues especially within the concept of supporting the patient through an adaptive process. The section on treatment of intestinal failure brought out some other very important issues regarding the use of specialized enteral formulations, and the management of high output jejunostomies, a critical aspect of appropriate attention to patients with intestinal failure. The outcomes of intestinal failure section, specifically chapters pertaining to the quality of life assessment and the patient’s perspective on intestinal failure, allow the
clinician to better understand the potential outcome markers to monitor for in those patients receiving therapy for intestinal failure. Finally, the surgical treatment of intestinal failure provided some new concepts with regard to innovative therapy and detailed the current state of small bowel transplantation, an up and coming therapy for small bowel dysfunction. There appears to be good uniformity within the style of the multiple authors within this book. However, there was great discrepancy with regard to the use of tables, graphs, and photographs. Some of the figures were excellent color photographs, whereas the black and white photographs were somewhat difficult to interpret. Some of the authors were able to use their tables very effectively for further explaining either a difficult topic or one that was voluminous in nature. Other tables were not as helpful because they simply repeated items that had been explained within the text. It is difficult to compare this book to other works, because it is the first within its class with a focus on intestinal failure. Bottom Line: I highly recommend this text book for those who are involved with the care of patients with intestinal failure or for those who want to become more familiar with the terminology, physiology, history, and future of intestinal failure.
MARK H. DeLEGGE, M.D., F.A.C.G., C.N.S.P. Section of Nutrition Digestive Disease Center Medical University of South Carolina Charleston, South Carolina Management of Chronic Viral Hepatitis. Edited by Stuart C. Gordon. 392 pp. $150.00. Marcel Dekker Inc., New York. ISBN 0-8247-0582-3. Web address for ordering: www. dekker.com This book aims to fill a gap in the available literature by providing both a comprehensive summary and a practical approach to the diagnosis and treatment of viral hepatitis. With contributions from distinguished scientists, it extensively covers the hepatitis viruses (HBV, HCV, HBV, and HEV). This will be a useful guide for gastroenterologists, hepatologists, nurse practitioners, and physicians in training. The text is well organized. Separate chapters are devoted to diagnosis, virology, and treatment. The sections pertaining to alternative treatments for HCV, treatment of patients with HCV who have persistently normal ALT levels, and management of interferon nonresponders are extremely useful, and all are well referenced. An algorithm for treatment of hepatitis B provides a concise treatment strategy, though expansion to
December 2002
include treatment approaches to patients with YMDD mutations would have been helpful. Sections on recurrent HBV and HCV after liver transplantation are well written, and include a comprehensive review of the literature on this difficult subject. These chapters should be extremely useful for transplant physicians. All chapters start with 2 or 3 case studies, each with a detailed laboratory evaluation. The cases are representative of commonly encountered patients in the hepatology clinic, and serve as a useful introduction to the subject addressed in that chapter. These well-presented case histories are a major strength of this textbook; they illustrate certain points in a way that no volume of discussion could duplicate. The editor should be commended for taking this case-based approach. However, I wish that each chapter also ended with a further discussion of the case (as in chapter 1), with a rationale for the recommended treatment approach. This would have provided additional guidance to fellows and non-hepatologists, and would have further enabled reader to use the book at the bedside. In addition, an algorithm or a table for different case scenarios regarding HCV also would have been useful. This book covers a major gap in the available literature in that it helps clinicians take a focused and concise bedside approach to viral hepatitis. Although it is well referenced, exhaustive reviews of the literature are avoided, allowing for easy access to information. Every month, a large volume of new information pertaining to HCV and HBV is published. By the time a book such as this one rolls off of the presses, there is often a considerable amount of new knowledge that did not make it into print. This information gap is encountered in every textbook, and this one is no exception. More current information on pegylated interferons in hepatitis B and C infections would have been helpful, for instance, especially since future HCV antiviral treatment is likely to be based primarily on PEG interferons. Yet, this is a minor drawback to an otherwise superbly written text, one that does not significantly limit the usefulness of the book. Bottom Line: A comprehensive review of viral hepatitis that offers an easy reference guide for everyday clinical practice.
SATHEESH NAIR, M.D. Department of Abdominal Organ Transplant Ochsner Clinic New Orleans, Louisiana Pediatric Gastroenterology and Nutrition in Clinical Practice. Edited by Carlos Lifschitz. 869 pp. $195.00. Marcel Dekker, Inc., New York, 2001. ISBN 0-8247-0510-6. Web address for ordering: www.dekker.com. One look at this book is all it takes to realize that Lifshitz’s textbook is something different. Instead of being tall, wide, and relatively flat, like most new medical textbooks, this one is thick and short. Pick it up and it is unusually heavy. Open it to any page, and the density of the small-print text printed on weighty, glossy pages is obvious. Illustrations are spare and
PRINT AND MEDIA REVIEWS
2155
practical. This book is not for casual browsing. It is a serious reference for those who want all the details and need to know them. Look closer, and there is more that is surprising. The table of contents reveals that more than half of all pages are devoted to topics in pediatric nutrition. Nutrition is not neglected in other pediatric gastroenterology references, but this one stresses the role of nutrition in childhood and in pediatric gastrointestinal disease. The amount of space devoted to nutrition allows extensive coverage of such diverse themes as growth factors, protein turnover, and metabolism, as well as more clinical chapters on obesity, eating disorders, failure to thrive, and breast feeding. In his preface to the text, Dr. Lifshitz tells us that his intention is to provide a reference that brings us up to date with the “most relevant new facts in molecular biology and genetics, as well as recently acquired clinical information, in conjunction with a practical approach to pediatric gastroenterology and nutrition.” The book’s title suggests that it is a clinical reference, but it is really intended to be much more. The list of authors is a roll call of distinguished multinational experts in nutrition and clinical gastroenterology. Together they have written an amazing array of chapters, some of which are very clinical and practical in nature, such as the chapter on “Feeding patients with acute diarrhea” to much more technical reviews of basic science, such as “New knowledge about protein,” which covers everything from RNA to ubiquitin. The chapters devoted to purely gastrointestinal disease, located in the last half of the text, provide the essential information about these topics. It is in this part of the book that the most practical clinical information may be found. The degree of compression required to cover each chapter in the limited space varies considerably, but generally works well. The best example is the chapter on liver disease, which successfully covers the meaty parts of a huge topic in only 50 pages. Some other clinical topics suffer from space limitations. One example is the chapter on peptic disease, which extensively covers the various etiologies of gastritis, but does not directly address more practical aspects of diagnosis and treatment. In most ways, the stated ambitions of the editor have been achieved. This is not a quick handbook for medical students to use during their third-year clerkships. It offers more, and in some cases, less than most primary care physicians are looking for. However, those who need a review of basic clinical principles can find what they are looking for in the final chapters. The intended audience of this book, including gastroenterologists, gastroenterology fellows, and readers who seek to deepen their understanding of nutrition in health and disease, will not be disappointed. Bottom Line: This book is a valuable resource and a real bargain.
WARREN P. BISHOP, M.D. Department of Pediatrics Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City, Iowa