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Neoplasms of the colon, rectum, and anus
GASTROENTEROLOGY 2000;119:1803–1804
PRINT AND MEDIA REVIEWS Lawrence S. Friedman, M.D. Print and Media Review Editor Gastrointestinal Unit Massachusetts General Hospital Boston, Massachusetts
Gastrointestinal Disease in Primary Care. Edited by Lyman E. Bilhartz and Carol L. Croft. 206 pp. $39.95. Lippincott Williams & Wilkins Co., Philadelphia, Pennsylvania, 2000. ISBN 0-683-30444-5. Gastrointestinal disorders are common in the general population. A recent survey by the Center for Health Outcomes Research in Baltimore, Maryland, reported that in the prior 3 months, approximately half of all Americans experienced significant upper gastrointestinal symptoms. In addition, it is estimated that each year irritable bowel syndrome accounts for about 12% of all primary care visits. In the current health care arena, the primary care physician has increasingly assumed the role of primary care giver for patients with many of the most common gastrointestinal ailments. Thus, it has become clinically important and economically prudent for primary care physicians to become familiar with the management of these disorders and perhaps most importantly when to consult a gastroenterologist. This book was written to address these evolving needs for the primary care provider. This soft-cover book text consists of 206 pages divided into 13 chapters that focus on the most common gastrointestinal disorders. The book is intended to be used by a variety of primary care providers, including general internists, family physicians, and nurse practitioners, as well as residents training in those fields. Most of the chapters were written by faculty from various divisions within the University of Texas Southwestern Medical Center. Each chapter is disease-based, rather than based on symptoms and signs. There are chapters on gastroesophageal reflux disease, Helicobacter pylori and peptic ulcer disease, gallstone disease, viral hepatitis, pancreatitis, infectious diarrhea, inflammatory bowel disease, colon cancer screening, irritable bowel syndrome, human immunodeficiency virus (HIV)-associated gastrointestinal disorders, diverticulitis, ischemic colitis, and perianal disease. All chapters are organized similarly, with each discussing various features of a particular disorder, including epidemiology, etiology, pathogenesis, diagnostics, and management strategies. Each chapter ends with sections on “when to refer,” “commonly asked questions,” and a “suggested reading list” of recent original publications. Although there are no color plates, there are numerous clear and concise tables and figures as well as useful common diagnostic algorithms. The information provided is largely current, although cisapride (now off the market) is still recommended as an option for gastroesophageal reflux disease. A particularly insightful chapter is entitled the “Rational Approach to Colon Cancer Screening,” and nicely reviews the general principles of screening and the data
to support the use of common diagnostic strategies. Furthermore, it provides up-to-date information on appropriate screening intervals for various degrees of risk, as well as cost-effectiveness. The chapter on HIV-associated gastrointestinal diseases is also good and provides an excellent overview of the common ailments affecting this large and diverse patient population. Despite the extensive information provided by this text, there are a few drawbacks. Most importantly, the book does not effectively address the concern facing most primary care providers, namely, the presenting symptoms and signs of the patient. Most providers are faced with the question of how to proceed when faced with a patient who comes in with specific complaints or signs, such as nausea, diarrhea, abdominal pain, or jaundice. One might prefer a format in which chapters focus on the differential diagnosis and evaluation of common gastrointestinal signs, symptoms, and laboratory tests. A useful chapter would have been on the approach to the asymptomatic patient with abnormal liver chemistries. Furthermore, information on screening for hereditary hemochromatosis, an entity that is increasingly recognized, is lacking. There is also little information about the large number of drugs used to treat patients, including information on cost comparisons, adverse effects, and drug interactions. Overall, a symptom- and sign-based approach might have been more practical. Expansion of the “when to refer” section in each chapter might have been more useful than in-depth discussions of pathophysiology. In the final analysis, the primary care provider is most interested in knowing when to refer a patient to a subspecialist consultant. Bottom Line: This textbook provides an excellent overview of the most common gastrointestinal disorders seen in primary care but may not equip the generalist provider with quick and effective diagnostic, therapeutic, and referral strategies.
DAVID G. FORCIONE, M.D. Medical Services Massachusetts General Hospital Boston, Massachusetts Neoplasms of the Colon, Rectum, and Anus. Edited by Philip H. Gordon, M.D., and Santhat Nivatvongs, M.D. 368 pp. Quality Medical Publishing, Inc., St. Louis, Missouri, 2000. ISBN 1-57629-124-7. This book gives testimony to the notion that progress in the management of a disease (in this case, colon neoplasia) may not always be measurable in the ability to alter its life history, but rather in understanding its pathophysiology and exploring
1804
PRINT AND MEDIA REVIEWS
methods of prevention and early detection, while developing strategies (in this case, operative) for better patient outcomes through more tolerable management options. As the authors state in their preface, the aim of this work is to provide the practicing surgeon with up-to-date knowledge on neoplasms of the colon, rectum, and anus and to review current information on genetics, imaging, sphincter-saving operations, and minimal-access surgical techniques. The major emphasis of the work is on interventional techniques, but there is certainly as much useful information for those involved in the various diagnostic maneuvers entailed. The text is easy to read, is well referenced, gives important detailed discussion of areas of controversy, and is extensively illustrated. Unfortunately, the gross pathology photographs have, in general, been poorly reproduced, making it difficult to discern the lesions they illustrate. The line drawings illustrating the steps in operative procedures are excellent and easy to follow. One of the great strengths of this book is the detailed discussion of genetic and pathobiological information on colorectal neoplasia that is currently available. It is presented in a clear comprehensive fashion. Another major attribute is the documentation of evidence on various sides of controversial issues, with attempted conclusions at the end of each discussion. In an undertaking as extensive as this, there will inevitably be some omissions or less adequately treated areas. It is disappointing, for example, to see so few endoscopic images. In
GASTROENTEROLOGY Vol. 119, No. 6
discussing surgical procedures, the authors are not as inclusive as in other areas of the book and tend to set forth their own preferences without so stating. They also do not address the emerging acceptance of combined open and laparoscopic procedures (“hand-assisted”) or the simultaneous use of rigid, flexible, and ultrasound endoscopic techniques, which are especially important to their targeted audience. Bottom Line: Despite some limitations, this book will have wide appeal to those in the many disciplines involved in the diagnosis and management of patients with colorectal neoplasms: general medical specialists, gastroenterologists, radiologists, oncologists of all stripes, and pain management specialists, to name a few. For students and trainees in any of these disciplines, such an up-to-date comprehensive and honest treatment of even controversial issues is a precious rarity. For the surgeon whose practice and academic activity is in colorectal surgery, this is a work to which repeated reference will be made, especially in attempts to sort out preferences in diagnosis or therapy.
KENNETH A. FORDE, M.D. Department of Surgery College of Physicians and Surgeons of Columbia University New York–Presbyterian Hospital New York, New York
PRINT AND MEDIA REVIEWS Lawrence S. Friedman, M.D. Print and Media Review Editor Gastrointestinal Unit Massachusetts General Hospital Boston, Massachusetts
Gastrointestinal Disease in Primary Care. Edited by Lyman E. Bilhartz and Carol L. Croft. 206 pp. $39.95. Lippincott Williams & Wilkins Co., Philadelphia, Pennsylvania, 2000. ISBN 0-683-30444-5. Gastrointestinal disorders are common in the general population. A recent survey by the Center for Health Outcomes Research in Baltimore, Maryland, reported that in the prior 3 months, approximately half of all Americans experienced significant upper gastrointestinal symptoms. In addition, it is estimated that each year irritable bowel syndrome accounts for about 12% of all primary care visits. In the current health care arena, the primary care physician has increasingly assumed the role of primary care giver for patients with many of the most common gastrointestinal ailments. Thus, it has become clinically important and economically prudent for primary care physicians to become familiar with the management of these disorders and perhaps most importantly when to consult a gastroenterologist. This book was written to address these evolving needs for the primary care provider. This soft-cover book text consists of 206 pages divided into 13 chapters that focus on the most common gastrointestinal disorders. The book is intended to be used by a variety of primary care providers, including general internists, family physicians, and nurse practitioners, as well as residents training in those fields. Most of the chapters were written by faculty from various divisions within the University of Texas Southwestern Medical Center. Each chapter is disease-based, rather than based on symptoms and signs. There are chapters on gastroesophageal reflux disease, Helicobacter pylori and peptic ulcer disease, gallstone disease, viral hepatitis, pancreatitis, infectious diarrhea, inflammatory bowel disease, colon cancer screening, irritable bowel syndrome, human immunodeficiency virus (HIV)-associated gastrointestinal disorders, diverticulitis, ischemic colitis, and perianal disease. All chapters are organized similarly, with each discussing various features of a particular disorder, including epidemiology, etiology, pathogenesis, diagnostics, and management strategies. Each chapter ends with sections on “when to refer,” “commonly asked questions,” and a “suggested reading list” of recent original publications. Although there are no color plates, there are numerous clear and concise tables and figures as well as useful common diagnostic algorithms. The information provided is largely current, although cisapride (now off the market) is still recommended as an option for gastroesophageal reflux disease. A particularly insightful chapter is entitled the “Rational Approach to Colon Cancer Screening,” and nicely reviews the general principles of screening and the data
to support the use of common diagnostic strategies. Furthermore, it provides up-to-date information on appropriate screening intervals for various degrees of risk, as well as cost-effectiveness. The chapter on HIV-associated gastrointestinal diseases is also good and provides an excellent overview of the common ailments affecting this large and diverse patient population. Despite the extensive information provided by this text, there are a few drawbacks. Most importantly, the book does not effectively address the concern facing most primary care providers, namely, the presenting symptoms and signs of the patient. Most providers are faced with the question of how to proceed when faced with a patient who comes in with specific complaints or signs, such as nausea, diarrhea, abdominal pain, or jaundice. One might prefer a format in which chapters focus on the differential diagnosis and evaluation of common gastrointestinal signs, symptoms, and laboratory tests. A useful chapter would have been on the approach to the asymptomatic patient with abnormal liver chemistries. Furthermore, information on screening for hereditary hemochromatosis, an entity that is increasingly recognized, is lacking. There is also little information about the large number of drugs used to treat patients, including information on cost comparisons, adverse effects, and drug interactions. Overall, a symptom- and sign-based approach might have been more practical. Expansion of the “when to refer” section in each chapter might have been more useful than in-depth discussions of pathophysiology. In the final analysis, the primary care provider is most interested in knowing when to refer a patient to a subspecialist consultant. Bottom Line: This textbook provides an excellent overview of the most common gastrointestinal disorders seen in primary care but may not equip the generalist provider with quick and effective diagnostic, therapeutic, and referral strategies.
DAVID G. FORCIONE, M.D. Medical Services Massachusetts General Hospital Boston, Massachusetts Neoplasms of the Colon, Rectum, and Anus. Edited by Philip H. Gordon, M.D., and Santhat Nivatvongs, M.D. 368 pp. Quality Medical Publishing, Inc., St. Louis, Missouri, 2000. ISBN 1-57629-124-7. This book gives testimony to the notion that progress in the management of a disease (in this case, colon neoplasia) may not always be measurable in the ability to alter its life history, but rather in understanding its pathophysiology and exploring
1804
PRINT AND MEDIA REVIEWS
methods of prevention and early detection, while developing strategies (in this case, operative) for better patient outcomes through more tolerable management options. As the authors state in their preface, the aim of this work is to provide the practicing surgeon with up-to-date knowledge on neoplasms of the colon, rectum, and anus and to review current information on genetics, imaging, sphincter-saving operations, and minimal-access surgical techniques. The major emphasis of the work is on interventional techniques, but there is certainly as much useful information for those involved in the various diagnostic maneuvers entailed. The text is easy to read, is well referenced, gives important detailed discussion of areas of controversy, and is extensively illustrated. Unfortunately, the gross pathology photographs have, in general, been poorly reproduced, making it difficult to discern the lesions they illustrate. The line drawings illustrating the steps in operative procedures are excellent and easy to follow. One of the great strengths of this book is the detailed discussion of genetic and pathobiological information on colorectal neoplasia that is currently available. It is presented in a clear comprehensive fashion. Another major attribute is the documentation of evidence on various sides of controversial issues, with attempted conclusions at the end of each discussion. In an undertaking as extensive as this, there will inevitably be some omissions or less adequately treated areas. It is disappointing, for example, to see so few endoscopic images. In
GASTROENTEROLOGY Vol. 119, No. 6
discussing surgical procedures, the authors are not as inclusive as in other areas of the book and tend to set forth their own preferences without so stating. They also do not address the emerging acceptance of combined open and laparoscopic procedures (“hand-assisted”) or the simultaneous use of rigid, flexible, and ultrasound endoscopic techniques, which are especially important to their targeted audience. Bottom Line: Despite some limitations, this book will have wide appeal to those in the many disciplines involved in the diagnosis and management of patients with colorectal neoplasms: general medical specialists, gastroenterologists, radiologists, oncologists of all stripes, and pain management specialists, to name a few. For students and trainees in any of these disciplines, such an up-to-date comprehensive and honest treatment of even controversial issues is a precious rarity. For the surgeon whose practice and academic activity is in colorectal surgery, this is a work to which repeated reference will be made, especially in attempts to sort out preferences in diagnosis or therapy.
KENNETH A. FORDE, M.D. Department of Surgery College of Physicians and Surgeons of Columbia University New York–Presbyterian Hospital New York, New York