First edition. Choichi Sugawa, Bernard Schuman, and Charles Lucas; eds. 564 pages. New York: Igaku-Shoin; 1992. $138.50.

The acquisition of information on the overall diagnosis and management of patients with gastrointestinal bleeding has become easier with the availability of this book. Any physician managing patients with gastrointestinal bleeding can reach for this book as a first resource. It contains the expected chapters on surgical, radiographic and endoscopic management of patients with gastrointestinal bleeding, including short-term management and identification of risk factors. It also covers topics such as hematologic problems in gastrointestinal bleeding and the approach to rebleeding after surgery for gastrointestinal bleeding. There is also an excellent, detailed chapter on the pathogenesis and treatment of hemorrhagic shock.

Many of the chapters contain important clinical tidbits. The chapter on angiographic management notes that the widely quoted rate of 0.5 mL/min for angiographically detectable bleeding was based on an experimental model that was incapable of maintaining blood loss at less than 0.5 mL per minute. It is therefore possible that even lower rates of blood loss could be angiographically detectable. This chapter also describes the "double ligation" angiographic technique that can be used to prevent recurrent gastrointestinal bleeding through collateral vessels. A chapter on surgical management contains an informative Table that lists the various reported (but not necessarily supported) indications for surgery for a bleeding peptic ulcer. The text also provides a discussion of the indications and timing of surgery for bleeding from lesions other than peptic ulcers, with the caveat that these recommendations have been extrapolated from the peptic ulcer surgery data, which may not be valid. The chapter on the surgical management of intestinal bleeding from sites distal to the ligament of Treitz even offers some recommendations on what to tell the patient regarding informed consent. Helpful tables exist throughout the book and include a list of the ten techniques for intraoperative localization of intestinal bleeding and a table listing the ulcerating diseases of the small intestine. The chapter on liver disease in gastrointestinal bleeding has a helpful table on the differential diagnosis of acute azotemia in the bleeding patient with liver disease. A table also provides quick reference to the Child Prognostic Score for patients who have had variceal bleeding.

This book is not without deficiencies, but they are infrequent. One problem in several chapters is the limited use of references to substantiate apparent statements of fact. This reviewer feels that authors of book chapters should be held to the same level of scientific accountability as are authors of articles published in peer-reviewed journals. Little is missing from this book regarding acute gastrointestinal bleeding, but no chapters deal specifically with occult or chronic obscure gastrointestinal bleeding. No discussion was provided of the use of ß-blockers in the prevention of bleeding or rebleeding from esophageal varices. The strengths of this book lie in its comprehensive review of the contributions of the various subspecialty disciplines in the diagnosis and management of gastrointestinal bleeding. It represents a central informational text that any physician can use as a resource for the clinical approach to patients with gastrointestinal bleeding.