Methods in disease: Investigating the gastrointestinal tract

GASTROENTEROLOGY 1999;116:1009–1011

PRINT AND MEDIA REVIEWS Lawrence S. Friedman, M.D. Print and Media Review Editor Gastrointestinal Unit, Blake 456D Massachusetts General Hospital Boston, Massachusetts 02114

Clinical Practice of Gastroenterology. Edited by Lawrence J. Brandt with F. Daum, L. S. Friedman, D. A. Peura, C. S. Pitchumoni, J. F. Reinus, J. E. Richter, A. Rogers, L. R. Schiller, and J. Van Dam. 1780 pp. $235.00. Churchill Livingstone, Philadelphia, Pennsylvania, 1999. ISBN 0-44306520-9. This multiauthored textbook is intended, as outlined by its editor-in chief Dr. Brandt, to be used as a ready reference for the practicing clinician. The 2-volume set authored by 281 contributors is divided into 9 sections, which include Esophagus, Stomach and Duodenum, Small Bowel, Colon, Liver, Gallbladder and Biliary Tract, Pancreas, Pediatric Gastroenterology, and Special Topics, such as gastrointestinal manifestations of AIDS and complications of endoscopy. Each section has its own associate editor. In addition to the text, the last section of each volume contains color plates referred to within the chapters. Somewhat unique to this general gastroenterology text is the inclusion of extensive chapters on liver disease and pediatrics. As one might expect in a text with so many contributors, there are variations in writing style, with many authors citing the literature broadly and others relying heavily on their own experience and publications. Nevertheless, the writing style flows smoothly, and the book is a fast and easy read. Commensurate with the goals of the book, there is a limited amount of text devoted to pathophysiology. However, there is sufficient background to gain an understanding of the issues. The goals are to provide clinically useful information in a concise and user-friendly format. In this regard, the text succeeds. Because of the large number of contributing authors, the subject matter is extensively divided into very limited topics, which results in some overlap of the material, as seen in the chapters ‘‘Symptoms and Signs of Small Bowel Disease’’ and ‘‘Infectious Diarrhea.’’ Although each is well written, there is duplication of material and some minor disparity in approach. The limited subject matter of each chapter allows for easy access to the associated bibliography. The references are as recent as possible with such a textbook and, unique to this publication, are frequently highlighted with annotations as to the content and relevance of the article and its relationship to the subject matter. This is an excellent concept that may set a new standard for future texts. There are many tables and figures that provide algorithms and illustration of concepts in a concise manner. Unfortunately, references to these are not printed in bold in the text, so when the reader studies a figure or table and wishes to return to the appropriate section of the text, it is not readily accessed. If there is one major failing of the book, it is the lack of color photography of endoscopic and histological images. There is an

atlas of some color photographs in the back of the text, but it is very limited and cumbersome to use. Bottom Line: Given the ready access to medical literature on the Internet, one wonders about the future of books of this type. This book is not, nor does it claim to be, an encyclopedic reference for the field. However, for the present, it would be a worthwhile addition to the desk-side library of clinical gastroenterologists, trainees, internists, and family practitioners. BENNETT E. ROTH, M.D. UCLA School of Medicine Los Angeles, California

Methods in Disease: Investigating the Gastrointestinal Tract. Edited by V. R. Preedy and R. R. Watson. 373 pp. $275.00. Greenwich Medical Media Ltd., London, England, 1998. ISBN 1-900151-014. Researchers have an ever increasing array of tools available to investigate the gastrointestinal tract in the normal and diseased state. This book aims to function as a ‘‘source of investigative techniques that can be applied to the gastrointestinal tract’’ and to illustrate their applicability to specific questions. The book represents an interesting and exciting concept. The editors have brought together an international cast of experts, 66 in all. Chapters conform to the same format, with an introduction, theoretical explanation, procedural techniques, animal studies, applicability, and finally a critical discussion, although the degree to which each section is discussed varies from chapter to chapter. The topics considered range from an evaluation of basic gut function in vivo and in vitro, to a variety of the available imaging modalities, to a detailed structural evaluation of the gastrointestinal tract at a glandular and cellular level. Because of the large numbers of contributors, different goals are set and met. However, each chapter attempts to discuss the limitations and potential errors of the various experimental approaches. Furthermore, some authors use specific research questions to illustrate the applicability of certain experimental approaches. Subjects such as the assessment of intestinal absorptive capacity and permeability in vivo, evaluation of cytokine profiles in the gastrointestinal tract, lipid peroxidation measurements in gastrointestinal tissues, and in situ hybridization techniques as applied to the gastrointestinal tract enable the reader to design and perform an actual experiment. However, there are other chapters that provide limited experimental detail. This is compensated by detailed reference lists accompanying most chapters. The chapters on assessing intestinal absorptive capacity and permeability in vivo and in vitro and ion transport in the gastrointestinal tract are particularly informative and detailed,

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providing a clear and concise introduction for the uninitiated. Likewise, there is an interesting overview on measuring cell proliferation, which is complemented by another fascinating chapter that looks at three-dimensional analysis of epithelial cell proliferation. Some of the investigational methods described, including lymph node studies, staining techniques, and flow cytometry, are widely applicable to other organ systems. The last few chapters of the book deal with a variety of tissue staining techniques as well as cell identification methods and provide very detailed protocols. These chapters, like most chapters in the book, are particularly well illustrated with color micrographs and diagrams and have an ample supply of experimental details and tables. They provide a great reference for those interested in tissue microscopy and cell identification. Color has also been used to show the effectiveness of immunomorphological and enzymohistochemical methods and other microscopic identification techniques. Although individual chapters aim to be comprehensive, the book itself does not. This is not a homogeneous book. The breadth of subjects discussed is focused. The editors have confined its scope to the gastrointestinal tract with little reference to the liver, biliary system, or pancreas. The choice of subjects is thus uneven. Although there are excellent chapters on endoscopic ultrasonography, Doppler sonography, and confocal microscopy, there is little or no mention of the potential roles of basic endoscopy, computerized tomography, or magnetic resonance imaging in the investigation of the gastrointestinal tract. There is excellent coverage of techniques applicable to gastrointestinal immunology, nutrition, and evaluation of mucosal function, with little or no attention to the evaluation of gastrointestinal endocrine function, growth factors in the gastrointestinal tract, or gastrointestinal microbiology. Similarly, with the burgeoning information on molecular biology and genetic information as it pertains to the gastrointestinal tract, no attention is paid to animal models of gastrointestinal disease or cell culture as a means of investigating gastrointestinal tract function, nor to advances in molecular biology and genetics that presently represent an increasing portion of our knowledge of gastrointestinal diseases. Bottom Line: There is a need for a book such as this. It contains many chapters that would be of interest to the clinician, including a basic chapter on ambulatory esophageal and gastric pH monitoring, motility measurements in the gastrointestinal tract, Doppler sonography, endoscopic ultrasonography, and Helicobacter pylori. Because it cannot possibly do justice to every investigational method applicable to the gastrointestinal tract, the areas covered are covered in an interesting, informative, and detailed manner and should prove beneficial to any investigator of the gastrointestinal tract. JAMES J. FARRELL, M.B. Gastrointestinal Unit Massachusetts General Hospital Boston, Massachusetts

GASTROENTEROLOGY Vol. 116, No. 4

Cholelithiasis: Causes and Treatment. By Fumio Nakayama, M.D. 300 pp. $69.00. Waverly Inc., York, Pennsylvania, 1997. ISBN 0-89640-334-3. For the past 40 years, Dr. Fumio Nakayama, Professor Emeritus of Surgery at Kyushu University School of Medicine, Fukuoka, Japan, has contributed benchmark studies on bile and gallstones and trained a generation of East Asian surgeoninvestigators. Now he has written a large, comprehensive, highly informative, and adroitly phrased monograph, Cholelithiasis, which goes beyond its subtitle, Causes and Treatment, to bring the reader to the cusp of the modern molecular biological and genetic era of bile and gallstone research. No creative investigator writes a book while active at the bench, so this work was begun only during his retirement. Dr. Nakayama’s thorough coverage of the literature, a staggering 1529 references, accurately and appropriately cited, ends in 1994. However, the mid-90s mark a watershed in gallstone/bile research and presaged a whole new world of thinking. During 1993–1995 researchers cloned the ileal sodium-coupled bile acid transporter from the hamster, discovered the quantitative trait locus in the inbred mouse for the first cholesterol gallstone gene, Lith1, and provided seminal studies on the knockout in the inbred mouse of Mdr2, the canalicular transmembrane translocator (‘‘flippase’’) for lecithin, which renders bile devoid of phospholipid and leads to liver disease. These articles heralded the new molecular biologic and genetic elucidation of the links between intestinal and canalicular biliary lipid pumps and bile formation and cholelithiasis. Although the author masterfully covers the history, taxonomy, pathobiology, epidemiology, physical chemistry, pathogenesis, diagnosis, and treatment of gallstones, he does not enter the molecular biological and molecular genetic arena. Nonetheless, producing a sole-authored monograph of this scope is an effort to be greatly admired, and this book represents one of the last important works of the classical gallstone decades. Is it written for too large an audience? Definitely no! The author adheres to a scholarly level of discourse, critically evaluates knowledge on a host of disciplines from the early 1950s, and relates it to all aspects of bile and gallstones in both experimental animals and humans. Moreover, he presents his critical deductions in lively, sometimes quaint but polished English prose. Who should buy this book? Anyone who wishes to be fully versed in the wide world of the now ‘‘classic’’ research on bile production and gallstone formation with particular focus on those ‘‘young Turks’’ entering the field at molecular biophysical, biological, or genetic levels, because these pages will allow the past to unfold gracefully for them. Also, clinicians seeking the basic scientific underpinnings of their clinical interests will be well served by the author, who explains complex biological processes in lively and simple prose and provides thorough guidance for management of the wide spectrum of medical and surgical maladies related to gallstone disease. Information can be acquired rapidly and easily because the book is refreshingly