Helen M. Shields, M.D. BookReviewEditor Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts 02215
Inflammatory Bowel Diseases. 2nd edition. Edited by R. N. Allen, M. R. B. Keighley, J. Alexander-Williams, and C. Hawkins. 666 pp. $125.00. Churchill Livingstone, Inc., New York, New York, 1990. ISBN: O-443-3819-8. The aim of this second edition is to cover the practical and academic developments in inflammatory bowel disease over the last 7 years. On the whole, the aim has been met in the field that has received the most emphasis, that is, the introduction of the 5-ASA group of compounds. For the most part, the references are up to date through the summer of 1989. The book is divided into nine sections covering history, genetics and epidemiology, pathophysiology, etiology, diagnosis, clinical presentation with natural history and prognosis, medical and surgical treatment, special problems, and other specific disorders. This laudable and comprehensive approach has resulted in a readable book of some 655 pages, including an excellent dissertation on the management of inflammatory bowel disease. There is also a particularly good review of surgical and nutritional therapy. It is disappointing that few words are devoted to the newer glucocorticosteroid preparations with high first-pass metabolism in the liver, which have major potential given their low rate of systemic side effects. These compoundstixocortal pivalate, budesonide, and fluticasone proprionate-allow a more selective topical therapy. The potency of budesonide is ZOOtimes that of hydrocortisone and 15 times that of prednisolone. There is a 90% first-pass hepatic metabolism to metabolites of very low potency. In contrast, hepatic first-pass metabolism is 20% for prednisolone. The newest compound in this category, fluticasone proprionate, given orally in a dose of 20 mglday, is not mentioned even though it was recently shown to be helpful in a pilot study on the treatment of mild and moderately active small intestinal and colonic Crohn’s disease [Gut 30:1480, 1989 (abstr)]. The index is well formulated, making it easy to find relevant material. The tables are clear. The figures, for the most part, are of high quality. The notable exception here is in the chapter devoted to pathology, in which there are excessive figures; several are of poor quality, and there is some repetition. This book relies heavily on multiple authors, with a uniformly high standard across the various chapters. There is new information concerning endoscopy, childhood inflammatory bowel diseases, and complications affecting the liver and biliary tract, as well as an update on the cancer risk in both ulcerative colitis and Crohn’s disease. The use of ileoanal pouches, the recent major advance in surgery, is well reviewed. The conservative approach to Crohn’s disease complicated by strictures using stricturoplasty is well presented.
There is a dissertation on sexually transmitted diseases, including the acquired immunodeficiency syndrome as it affects the gastrointestinal tract; this is very helpful. Also included are such rarities as Chagas’ disease affecting the bowel. Overall, there is a commendable lack of repetition in this book. It will find favor among those keenly interested in inflammatory bowel disease and is highly recommended for those active in the treatment of these patients. It should be readily available in libraries for those who only see these patients occasionally and for medical students. This book compares very favorably to its main competitor, Inflammatory Bowel Disease, 3rd edition, J. B. Kirsner and R. G. Shorter, published by Lea and Febiger of Philadelphia in 1988. Certain features such as extracolonic manifestations are covered in a remarkably similar manner. The more recent book contains the more recent ideas on etiology, pathogenesis, epidemiology, and newer therapies. C. NOELWILLIAMS, M.D. Dalhoude University Halifax, Nova Scotia
Coloproctology: Basic Knowledge for Clinical Practice. Edited by R. Caprilli and A. Torsoli. 241 pp. $56.00. International University Press, Rome, Italy, 1990. ISBN: 88-8531400-7. Diseases of the colon and rectum are common, yet poorly understood and difficult to treat. This book attempts to review and update the latest information on colorectal physiology and pathophysiology, placing laboratory and experimental information in perspective with clinical disease presentation and management. The book consists of thirteen chapters written by a team of international experts and encompasses a large body of information. A wide variety of topics are presented, including colorectal musculature and motility, colonic water and electrolyte transport, mucosal immunology, and surgical and pharmacological management of colorectal diseases. The book also includes chapters on unique issues frequently not addressed in standard textbooks of gastrointestinal physiology or pathophysiology. These issues include gastrointestinal microflora, pathophysiology of pelvic floor disorders, and decision analysis in coloproctology. Each chapter is well referenced, and in most instances, illustrations, tables, and figures are clear and informative. The editors clearly intended to target an audience of practicing physicians and surgeons, their goal being to provide these individuals with an understanding of basic principles and information useful to their clinical practice. In this regard, the book is partially successful. Many of the