Textbook of Secretory Diarrhea

Textbook of Secretory Diarrhea

GASTROENTEROLOGY BOOK 1991;101:271-273 REVIEWS Helen M. Shields, M.D. Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston, Massa...

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Helen M. Shields,


Book Review Editor Beth Israel Hospital 330 Brookline Avenue Boston, Massachusetts


Textbook of Secretory Diarrhea. Edited by Emanuel Lebenthal and Michael E. Duffey. 456 pp. $110.00. Raven Press, New York, New York, 1990. ISBN: O-88167-666-7.

It has been approximately 10 years since a definitive review of the mechanisms of intestinal water and electrolyte transport and secretory diarrhea has appeared in the American literature. Useful monographs on one or the other of these two subjects have been published more recently. Thus this volume is overdue. This book derives from a conference on these topics held in Buffalo, New York, in 1987. However, it is a fairly complete piece of work with chapters 10-15 pages long containing useful illustrations, graphs, and tables. This book is aimed at both researchers and clinicians, and it focuses on the functions and dysfunctions of the intestinal mucosa rather than on gut smooth muscle. Furthermore, the clinical chapters are directed more toward pathophysiology than toward clinical description. The book is divided into five sections of three to eight chapters each; each chapter is written by an expert or experts in the field. The first three sections deal with the basic science of intestinal electrolyte transport. Regulation of transport by the enteric nervous system and by immune cells and their products, i.e., eicosanoids, constitute the first three chapters. This is the first text I have seen that defines the immune system as an important regulatory system for intestinal electrolyte transport. Thus, it heralds an emerging new area of research. The second section deals with the carriers and channels that transfer electrolytes from one side of the epithelium to the other. There are definitive reviews of Cl- secretion and absorption, of K’, HCO,-, and sugar transport, and of the role of the paracellular pathway in both electrolyte and water absorption; the last is a relatively old concept that has taken on new meaning and significance in recent years. The third section deals with signal transduction and contains chapters on enterocyte receptors for both bacterial secretagogues and neurohumoral agents, on transduction of receptor signals via G proteins, and on cyclic nucleotide-, calcium-, and phospholipid-dependent protein kinases. The last two sections deal with clinical issues: the diarrheas caused by bacterial enterotoxins, parasites, bile acids, and neuroendocrine tumors and their therapy with oral replacement solutions, a,-adrenergic agents, eicosanoid synthesis inhibitors, opiates, and somatostatin. There is much to like about this book. It is timely. The chapters are authoritative and for the most part well written. It contains useful information for someone such as this reviewer, a researcher in the field. Furthermore, new postdoctoral fellows in my unit have also found it a useful introduction to this area of medicine and science. I particularly enjoyed the chapters on G proteins, protein kinases,

the mechanism of action of opiates, and childhood secretory and congenital diarrheas, all areas outside of my own particular expertise. The book would have been even better if a few additional chapters had been included. Knowledge of how the immune system regulates transport has exploded in the last 5 years, and information might have been included about some of the recently recognized immune mediators that appear to regulate transport, e.g., oxyradicals, platelet-activating factor, and cytokines. There are no definitive chapters on mechanisms of sodium absorption, e.g., sodium-hydrogen exchange or amiloride-sensitive sodium channels. Inhibition of sodium transport by protein kinases and enhancement of sodium transport via the aldosterone system are both important issues in the biology of diarrhea1 diseases. In the clinical sections, chapters on rotavirus diarrhea, on the diarrheas of invasive microorganisms, and on inflammatory bowel disease would have been useful. One might argue that these are not secretory diarrheas, but emerging knowledge of the effects of immune mediators on electrolyte transport is changing our concepts of these diseases. The omissions make one question whether the book should be labeled a “textbook.” It certainly is, using the definition in Webster’s dictionary, a “book used in the study of a subject,” but not necessarily “one containing a presentation of the principles of a subject,” at least not all of the principles. But let me not criticize too harshly. This book is useful, well written, and well edited, and with only the minor omissions noted, it is complete. It should be on the shelves of every investigator studying intestinal water and electrolyte transport and of those interested in diarrhea1 diseases. Furthermore, it should be available for all clinicians who want access to an up-to-date review of the basic science, pathophysiology, and treatment of diarrhea1 diseases. DON W. POWELL, M.D.

The Universityof North Carolina School of Medicine Chapel Hill, North Carolina

Annual of Gastrointestinal Endoscopy 1989 and Annual of Gastrointestinal Endoscopy 1990. Edited by P. B. Cotton,

G. N. J. Tytgat, and C. B. Williams. 1989 volume, $70.00. 1990 volume, 167 pp, $80.00. Current Limited, London, England. ISBN: 0952-6293.

185 pp, Science

When you see these books, you will want to pick them up and thumb through them. They are oversized, soft-cover books published by Current Science Ltd. of London, England, which publishes Current Opinions in Gastroenterology, a series of annotated bibliographies of the world literature with review articles. This series seems to be a