Neil McIntyre, Jean-Pierre Benhamou, Johannes Bircher, Mario Rizzetto, and Juan Rodes; eds. 1630 pages. New York: Oxford University Press; 1991. $295.00.

The rapid and unprecedented growth of knowledge in the diagnosis and treatment of liver disease has produced an abundance of new textbooks on the subject. Perhaps this is because hepatology, until about 20 years ago, had few ways to treat specific (especially chronic) conditions and was primarily an academic, diagnostic discipline. With the advent and success of liver transplantation and the introduction of effective therapies for a range of inflammatory parenchymal disorders, physicians have begun to look at patients with liver disease with a greater degree of enthusiasm and interest. This has spawned a plethora of new books on the subjects. Besides the classic tomes of Sherlock (Diseases of Liver and Biliary System, eighth edition, 1989, $99.95), Schiff (Diseases of the Liver, sixth edition, 1987, $165), and the relative newcomer Zakim and Boyer (Hepatology, second edition, 1990, $245), there are Kaplowitz (Liver and Biliary Diseases, 1992, $105), Gitnick (Diseases of the Liver and Biliary Tract, 1992, $95), and, most notably, The Oxford Textbook of Clinical Hepatology. The latter treatise is an impressive effort and will surely invite comparison with the already established Sherlock, Schiff, and Zakim and Boyer.

The approach of the Oxford book is decidedly international—there are five European editors and over 200 contributors, many of whom have themselves written books on liver diseases—and comprehensive. The chapters on alcohol, for example, cover epidemiology, pathology, pathogenesis, natural history, diagnosis, management, and extrahepatic manifestations in 65 densely filled pages covered with numerous charts, graphs, and tables. Each aspect of the disease is fully discussed. Nonalcoholic fatty liver, usually presented within metabolic disorders in other textbooks (Schiff notwithstanding), is discussed here in a separate chapter. Sherlock probably set this precedent in her splendidly lucid discussion of the topic, though both Schiff and Zakim and Boyer opted to discuss various aspects of the condition (as with ascites) within different chapters on cirrhosis, alcoholic hepatitis, portal hypertension, and complications of liver disease.

The presentation of ascites is similarly broad-ranging; 35 pages of text are devoted to fluid treatments, the role of the kidney, theories of pathophysiology, and treatment options. The discussion is current and includes recent studies of large-volume paracentesis, as well as of the serum-ascites albumin gradient, in elucidating the causes of ascites. Alas, use of the transjugular intrahepatic portosystemic shunt (TIPS) procedure for diuretic-resistant ascites is too recent to warrant even the briefest of mentions.

Hepatitis C and liver transplantation are relatively new to hepatology textbooks. The coverage on hepatitis C is obviously limited to discussion on non-A, non-B hepatitis in Schiff and Zakim and Boyer because of the recent identification of the virus. Schiff is the oldest and therefore has the least coverage, Sherlock notwithstanding; indeed, an eight-page supplement to her book was published in 1991 simply to describe the latest developments in the disease. The Oxford text has a 12-page chapter, not including an introductory chapter on hepatitis viruses in general; it covers some recent interferon studies and includes extensive references up to 1991. Liver transplantation is presented succinctly in all of these books, with comparable discussion of candidate selection, operative procedures, and postoperative complications and management. The Oxford book's multiauthored chapter includes Dr. Starzl (as does Schiff) and is incorporated within the most extensive section that is available on surgery as it relates to liver disease. This section features innumerable details, from the anesthesiologist's perspective to all technical aspects of the surgery.

Truly encyclopedic in nature, The Oxford Textbook of Hepatology appears a favorite to become the liver text of reference. Its significant cost should not be a deterrent to purchase. A review of just a few subjects does not do justice to the extensive wealth of experience reflected in each of its 137 chapters, although many experts are sure to quibble with the opinions expressed within. For example, in the discussion of the treatment of autoimmune chronic active hepatitis, insufficient support is provided for the authors' approach, and alternative therapies are inadequately addressed. If one should feel overwhelmed by the book's vast knowledge base, there is probably no better place to turn than to Sherlock, which remains the best text for an introduction to liver diseases. The Oxford book is not for cover-to-cover reading but rather should be readily available (on your desk) for state-of-the-art consultation in the diagnosis and management of almost any type of liver disease. Clearly, it belongs in the library of every practicing gastroenterologist, hepatologist, skilled internist, abdominal surgeon, and major medical center. It is an important addition to the literature.