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Trends in inflammatory bowel disease therapy
GASTROENTEROLOGY
1992;103:713-714
BOOK REVIEWS Helen M. Shields, M.D. Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts
02215
Trends in Inflammatory Bowel Disease Therapy. Edited by C. N. Williams. 462 pp. $145.00. Kluwer Academic Publishers, Dordrecht, The Netherlands, 1991. ISBN 0-79238952-2.
Coeliac Disease: 40 Years Gluten-Free. Edited by M. L. Mearin and C. J. J. Mulder. 213 pp. $98.50. Kluwer Academic Publishers, Dordrecht, the Netherlands, 1991. ISBN O-7923-1160-4.
This book is the proceedings of a Falk Symposium held at Halifax, Nova Scotia, Canada, June 6-9, 1990. The symposium, designed for practicing gastroenterologists, gave an overview of current thinking on the pathogenesis and management of inflammatory bowel disease (IBD) and included a series of talks on the emerging role of new salicylates in IBD therapy. Many of the presentations were made by leading active investigators and reflect the most current work in IBD. As with most symposium proceedings, this book contains a large number of brief chapters focusing on circumscribed topics. The emphasis is on presenting recent work rather than on integrating recent work into the framework of established therapy. The first section includes seven chapters that review the current thoughts on the pathogenesis of IBD. These chapters are especially well done, with lucid discussions of difficult topics. This section is followed by six chapters on diagnostic methodologies in IBD emphasizing recent developments. This is followed by a section on lifestyle issues such as smoking and IBD. The next section includes six chapters on carcinoma in IBD with discussions of the role of oncogenes and the use of flow cytometry. A presentation on surveillance programs for dysplasia in ulcerative colitis and a counterpresentation questioning the utility of surveillance programs are also included. A relatively brief section discussing new trends in medical therapy includes presentations on the role of budesonide and fluticasone in ulcerative colitis. However, there is no integrated discussion of the current medical management of IBD. The topic dealt with in greatest depth is the role of the newer salicylate compounds in the management of IBD. Thirteen presentations on this topic include a considerable amount of original data. Collectively, these presentations give a good overview of the current thinking in this area. This text is the proceedings of a symposium and does not claim to be a textbook on IBD. It is not as comprehensive as any of several recent textbooks on IBD, such as Inflammatory Bowel Disease by J. Kirsner and R. Shorter. Trends in Inflammatory Bowel Disease Therapy will be more useful for a reader seeking a series of brief, well-focused reviews on current topics in IBD than for a reader seeking a reference text.
On May 22,1991, a symposium on celiac disease whose purpose was to commemorate the pioneering work of W. K. Dicke, the famed Dutch pediatrician, was held in Leyden, the Netherlands. Beginning as early as 1932, Dicke made the initial observations that led to the understanding that wheat gluten (and more broadly, gluten from barley, rye, and oats) was injurious to the small bowel mucosa of susceptible individuals. Celiac disease is much more prevalent in Europe than in America and leads to debilitating malabsorption in patients, often with severe consequences. If the disease is untreated, death may result. Before Dicke, physicians frequently could only watch helplessly as their patients inexorably slid down the abyss. In 1950, Dicke published a well-documented Ph.D. thesis spelling out the data linking gluten to celiac disease and making the leap to the clinical application of the glutenfree diet in the treatment of the condition. Since then, scientists have been trying to refine this observation to identify the elusive mechanism of tissue injury by gluten. Over the years it has become clear that genetic issues involving HLA markers (HLA B8, DR3, DP, DQ) may have direct relevance to disease pathogenesis. Others have shown that immune factors play a role at the level of tissue injury, so that cytotoxic lymphocytes and antibody-producing cells are at work in the mucosa. Still others have developed in vitro systems using organ culture techniques to study disease elements under controlled circumstances. During this symposium, 250 experts from an international field presented data from ongoing research on multiple issues, including those mentioned above. Of these, nearly 60 items are presented in this short book. The presentations are all quite brief, in abstract form and generally 1-2 pages in length. The presentations are a potpourri of activity in the field meant to entice the reader to pursue the matter further. Although the serious student of celiac disease will be left unsatisfied by the brevity of the presentations, the more casual aficionados will find the proceedings of interest to direct their attention to areas of current research activity. This is a book that will be found and read most likely in the research library.
WILLIAM
F. STENSON,
Jewish Hospital Washington University St. Louis, Missouri
M.D.
MYRON
FALCHUK,
New England
School
of Medicine
Harvard Boston,
M.D.
Deaconess Medical School Massachusetts
Hospital
1992;103:713-714
BOOK REVIEWS Helen M. Shields, M.D. Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts
02215
Trends in Inflammatory Bowel Disease Therapy. Edited by C. N. Williams. 462 pp. $145.00. Kluwer Academic Publishers, Dordrecht, The Netherlands, 1991. ISBN 0-79238952-2.
Coeliac Disease: 40 Years Gluten-Free. Edited by M. L. Mearin and C. J. J. Mulder. 213 pp. $98.50. Kluwer Academic Publishers, Dordrecht, the Netherlands, 1991. ISBN O-7923-1160-4.
This book is the proceedings of a Falk Symposium held at Halifax, Nova Scotia, Canada, June 6-9, 1990. The symposium, designed for practicing gastroenterologists, gave an overview of current thinking on the pathogenesis and management of inflammatory bowel disease (IBD) and included a series of talks on the emerging role of new salicylates in IBD therapy. Many of the presentations were made by leading active investigators and reflect the most current work in IBD. As with most symposium proceedings, this book contains a large number of brief chapters focusing on circumscribed topics. The emphasis is on presenting recent work rather than on integrating recent work into the framework of established therapy. The first section includes seven chapters that review the current thoughts on the pathogenesis of IBD. These chapters are especially well done, with lucid discussions of difficult topics. This section is followed by six chapters on diagnostic methodologies in IBD emphasizing recent developments. This is followed by a section on lifestyle issues such as smoking and IBD. The next section includes six chapters on carcinoma in IBD with discussions of the role of oncogenes and the use of flow cytometry. A presentation on surveillance programs for dysplasia in ulcerative colitis and a counterpresentation questioning the utility of surveillance programs are also included. A relatively brief section discussing new trends in medical therapy includes presentations on the role of budesonide and fluticasone in ulcerative colitis. However, there is no integrated discussion of the current medical management of IBD. The topic dealt with in greatest depth is the role of the newer salicylate compounds in the management of IBD. Thirteen presentations on this topic include a considerable amount of original data. Collectively, these presentations give a good overview of the current thinking in this area. This text is the proceedings of a symposium and does not claim to be a textbook on IBD. It is not as comprehensive as any of several recent textbooks on IBD, such as Inflammatory Bowel Disease by J. Kirsner and R. Shorter. Trends in Inflammatory Bowel Disease Therapy will be more useful for a reader seeking a series of brief, well-focused reviews on current topics in IBD than for a reader seeking a reference text.
On May 22,1991, a symposium on celiac disease whose purpose was to commemorate the pioneering work of W. K. Dicke, the famed Dutch pediatrician, was held in Leyden, the Netherlands. Beginning as early as 1932, Dicke made the initial observations that led to the understanding that wheat gluten (and more broadly, gluten from barley, rye, and oats) was injurious to the small bowel mucosa of susceptible individuals. Celiac disease is much more prevalent in Europe than in America and leads to debilitating malabsorption in patients, often with severe consequences. If the disease is untreated, death may result. Before Dicke, physicians frequently could only watch helplessly as their patients inexorably slid down the abyss. In 1950, Dicke published a well-documented Ph.D. thesis spelling out the data linking gluten to celiac disease and making the leap to the clinical application of the glutenfree diet in the treatment of the condition. Since then, scientists have been trying to refine this observation to identify the elusive mechanism of tissue injury by gluten. Over the years it has become clear that genetic issues involving HLA markers (HLA B8, DR3, DP, DQ) may have direct relevance to disease pathogenesis. Others have shown that immune factors play a role at the level of tissue injury, so that cytotoxic lymphocytes and antibody-producing cells are at work in the mucosa. Still others have developed in vitro systems using organ culture techniques to study disease elements under controlled circumstances. During this symposium, 250 experts from an international field presented data from ongoing research on multiple issues, including those mentioned above. Of these, nearly 60 items are presented in this short book. The presentations are all quite brief, in abstract form and generally 1-2 pages in length. The presentations are a potpourri of activity in the field meant to entice the reader to pursue the matter further. Although the serious student of celiac disease will be left unsatisfied by the brevity of the presentations, the more casual aficionados will find the proceedings of interest to direct their attention to areas of current research activity. This is a book that will be found and read most likely in the research library.
WILLIAM
F. STENSON,
Jewish Hospital Washington University St. Louis, Missouri
M.D.
MYRON
FALCHUK,
New England
School
of Medicine
Harvard Boston,
M.D.
Deaconess Medical School Massachusetts
Hospital