Joel S. Levine. 495 pages. St. Louis, Missouri: B. C. Decker; 1992. $69.00.

Many books have been written on the subject of gastrointestinal disorders. Indeed, it might be argued that we have too many textbooks on general gastroenterology to make it possible for a new book to provide additional, substantive information. It is therefore a pleasure to see that the approach taken by Dr. Levine on the current practical decision-making process for common patient problems in gastroenterology results in a novel and useful textbook. Dr. Levine has centered the decision-making process around frequently encountered clinical situations. The topics include presenting symptoms, physical signs, laboratory abnormalities, specific disease entities, and the use of diagnostic procedures. Thus, all gastrointestinal situations that may need to be considered in an individual patient are covered.

Each individual problem is addressed in two ways. A comprehensive decision-making tree outlining the different pathways by which a physician might wish to proceed is presented on the right-hand page. The decision-making trees are concise, easy to read, up to date, and worthwhile to follow step by step. The tree is accompanied on the left-hand page by four to seven paragraphs discussing in detail major branch points within the decision tree. It is encouraging to note that a succinct, practical, and relevant summary is provided without unnecessary detail for any of the important issues in each area. In addition, intermittent figures and a small number (3 to 8) of selective references for each topic are included. The references are to articles by the leaders in the areas, and include both up to date, lengthy, clinically relevant reviews and new advances in the peer-reviewed clinical research literature.

To see if the decision-making trees were useful, I asked two gastroenterology fellows to use the book for a week at a time; both fellows found the suggested procedures, recommended treatments, written comments, and references excellent and very helpful. I also used the book for treating a few of my own patients and likewise found the written and diagrammed recommendations correct and useful. Dr. Levine's book should therefore be valuable to physicians seeing a significant number of patients with gastrointestinal disorders. It will certainly be a useful reference for internists and general practitioners to use for an occasional patient, while gastroenterology fellows and practicing gastroenterologists may find reason to use it regularly. This book is also well suited for academic as well as clinical settings. I would therefore recommend this book highly as both a useful outline and concise, accurate summary of our current approach to important clinical issues and patient problems in gastroenterology.