The first major gastroenterology textbook was published in 1946 by Henry Bockus. During the ensuing four decades, this text blossomed to become a multiauthor, multivolume encyclopedia; the next edition will appear later this year. In 1970, a single-author work by Howard Spiro appeared; this was written specifically for the practicing gastroenterologist. Three years later, the first edition of Sleisenger and Fordtran's Textbook of Gastrointestinal Disease was published. In contrast to Spiro's text, this multiauthor endeavor reviewed not only clinical gastroenterology but physiology and pathophysiology as well, and it quickly became the standard with which other texts have been compared.
During the last decade, many gastroenterology texts have appeared, attempting to fill a perceived void, create a niche, or compete directly with Sleisenger and Fordtran. Thus, different types of books are now available to suit any need. My review contrasts and compares these texts in an effort to help physicians in different disciplines select the appropriate one.
Gastrointestinal Disease: Pathophysiology, Diagnosis, and Management
Fifth edition. M.H. Sleisenger, J.S. Fordtran, B.F. Scharschmidt, and M. Feldman; eds. Philadelphia: W.B. Saunders; 1993. $185.00.
Long considered the standard, the latest edition of Sleisenger and Fordtran's text includes additional improvements. The general outline and consistency of the text remains unaltered. Sections of color endoscopic photographs now appear at the front of both volumes for easy reference. The initial four chapters deal with the biology of the gastrointestinal tract, including gastrointestinal hormones, immunology, and neoplasia-oncogenesis, and with psychosocial issues. A section is devoted to multisystem diseases involving the gastrointestinal tract and is followed by the traditional organ system-based approach to gastrointestinal disease. Embryology, anatomy, and physiology are discussed in chapters devoted to specific organs. The biliary tract and ascites are reviewed but parenchymal liver disease is not. The final section of the book deals with selected nutritional topics. The index is user-friendly; page numbers of specific volumes are provided at the bottom of each page.
This edition has retained the excellent features we have come to expect from this text. Several sections, such as "Gastric Secretion in Health and Disease" and "Crohn's Disease" have been improved by new authors. Areas of controversy and rapid advancement, such as Helicobacter pylori, the acquired immunodeficiency syndrome, and laparoscopic surgery, are adequately covered. Cartoons and figures are appropriate, helpful, and of good quality. Algorithms are used in some chapters and aid in summarizing approaches to specific problems. Therapeutic recommendations have been improved, although those for some conditions are still lacking (for example, those for the irritable bowel syndrome). The references are extensive and up-to-date.
All in all, the modest changes made have improved what was already an outstanding text; the addition of new authors and an increased emphasis on treatment have improved the book's value. This text has consistently offered extreme readability and remains aesthetically pleasing and easy to use.
Textbook of Gastroenterology
T. Yamada, D.H. Alpers, C. Owyang, D.W. Powell, and F.E. Silverstein; eds. Philadelphia: J.B. Lippincott; 1991. $195.00.
The espoused purpose of this textbook is to "teach the scientific basis of gastroenterology, to provide practical approaches to common gastrointestinal problems, to serve as an encyclopedic reference for gastrointestinal diseases, and to indicate the current applications and future directions of the technology of gastroenterology." To fulfill these goals, the editors have attempted to develop an integrated approach to science, technology, and clinical practice, and to this end have summoned a cadre of respected basic and clinical investigators in gastroenterology.
The text is organized into three main sections. The first 26 chapters deal with the basic mechanisms and physiology of the gastrointestinal tract and include discussions of the nervous system, hormones, motility, secretion and absorption, and nutrition. The topics chosen are appropriate and encyclopedic. Liberal use is made of cartoons, figures, and tables, which aid the reader's comprehension. Despite the complexity of some subjects, the material is relatively easy to read.
The second section discusses approaches to specific problems such as gastrointestinal bleeding, abdominal pain, and diarrhea. These pragmatic chapters serve as a focal point for approaching a symptom complex rather than a specific disorder. Algorithms help summarize diagnosis and therapy; treatment options are broad and well formulated. Approach to nutrition, genetic counseling, advice for travelers, and public health are reviewed; one would not expect to find these topics reviewed here. Specific liver disorders addressed include ascites, jaundice, and abnormal liver tests, which are the most common hepatobiliary symptom complexes evaluated by clinicians.
The final section incorporates the conventional organ system-based approach to gastrointestinal disease. Sections that cover the anatomy and physiology not reviewed in section one are followed by chapters on specific diseases. Generous use is made of cartoons, tables, radiographs, and pathologic material. Recommendations for the approach to diagnosis and management are authoritative, and the references are up-to-date. Disorders of the gallbladder and biliary tree are discussed but parenchymal liver diseases are not. The final chapters complete this gastroenterologic encyclopedia with discussions of diagnostic and therapeutic endoscopy and radiographic techniques, including magnetic resonance imaging and angiography, paracentesis, and a potpourri of other topics related to diagnostic and therapeutic procedures.
Section headings are in color and the upper right-hand corner of each page lists the topic discussed on that page; these details provide great assistance to the reader looking for a specific section or topic. References to other chapters are listed at the end of each chapter, although in some cases the voluminous lists prohibit meaningful cross-referencing; review of the index would be easier. The small lettering of the text, although necessary, will intimidate some readers. Color figures emphasize the visual aspects of gastroenterology, although they are only found in the front of volume 1. Most of the endoscopic photographs were produced using fiberoptic technology and are of variable quality. A separate atlas of gastroenterology is available.
Clinical Gastroenterology
Fourth edition. M. Spiro. New York: McGraw-Hill; 1993. $135.00.
Dr. Spiro has enlisted the aid of other experienced clinicians at Yale in updating this text. Despite the addition of new authors, Spiro's unique style, pragmatic approach, and at times frank humor still permeate the entire text. Although a multiauthor text from a single center may suffer from bias, this one does not seem to do so.
The book is arranged in the conventional style of organ system-based disease and has specific sections for peptic ulcer and inflammatory bowel disease. Each section contains a brief review of anatomy and, in some cases, physiology. Although abbreviated, the discussion of gastric acid secretion is quite readable, even for the novice. Discussions of specific entities are organized under the following headings: incidence, pathogenesis, pathology, clinical features, diagnosis, and treatment. Discussions of imaging methods are accompanied by representative illustrations. Disorders of the biliary tree and the gallbladder are included. Unlike the other major gastroenterology texts, this book deals with parenchymal liver disease, including hepatitis, neoplasms, and metabolic disorders. Recommendations are appropriate, although many could be expanded, such as those for reflux disease. References are limited but are appropriately selected and up-to-date. Because the book was published in 1993, controversial topics are addressed, including recommendations for Helicobacter pylori therapy.
The text is easy to use and attractive; it has an abundance of outstanding photoµgraphs and radiographs illustrating various disease entities. The reader will note the relative lack of algorithms and tables; in some situations (differential diagnosis of ascites, for example) tables would be a useful addition. The separation of Crohn disease into small- and large-bowel disease may cause confusion; these two chapters could be combined and condensed into one large chapter. Clostridium difficile colitis is discussed in the section on small-bowel disease as well as in the section on the colon. Similarly, cholera is addressed in the section on large-bowel disease although it would be more appropriate in the section on the small intestine. Color endoscopic photographs are included in the middle of the textbook. Although produced with fiber-optic technology, these are generally outstanding, but most of the endoscopic photographs are upside down and should be corrected in the next edition.
The textbook is well-organized and the writing style we have come to expect and enjoy makes for comfortable and relaxed reading, in contrast to the sterile feeling imparted by most authoritative textbooks.
Clinical Gastroenterology
Second edition. E. Achkar, R.G. Farmer, and B. Fleshler; eds. Malvern, Pennsylvania: Lea and Febiger; 1992. $115.00.
This modest-sized textbook is directed to the practicing physician in medicine or surgery, house officers, and medical students. It represents an attempt to draw on the vast clinical experience of physicians from a single multispecialty clinic. Necessarily, then, the book's overall success depends on the expertise of each contributor; this is reflected in the inconsistent chapter quality. In addition, there is the potential for an institutional bias.
The initial 21 chapters deal with the presenting manifestations of gastrointestinal disease and are followed by a traditional organ system-based review. Seven chapters are devoted to selected aspects of liver disease. The initial chapters provide a ready reference for busy clinicians interested in reviewing an approach to a common clinical problem. In general, these chapters are of an appropriate length and complexity, given what I perceive to be the intended audience. Chapters on eating disorders and abdominal trauma probably could have been left out. Although appropriately used in some chapters, more algorithms summarizing the approach to specific clinical problems would further enhance the value of this section for the busy physician. Notably absent is a discussion of the approach to the guaiac-positive stool in the chapter on gastrointestinal bleeding, although this chapter devotes a full page to gastrointestinal bleeding of obscure origin. Combining chapters 8 and 10 would be appropriate, and the discussion of nonulcer dyspepsia, a common clinical problem, should be expanded.
The chapters devoted to organ-based diseases emphasize diagnosis and management with little discussion of pathophysiologic mechanisms and gastrointestinal physiology. They are easy to read and summarize useful clinical information. Although the book was published in 1992, many reference lists are out of date and lack important recent contributions. Some chapters are also outdated because of rapid advancements in the field, such as those on Helicobacter pylori and hepatitis C. Notably absent is a discussion of the gastrointestinal complications of the acquired immunodeficiency syndrome. Chapters devoted to liver disease are appropriate only for those interested in a general overview of common diseases, because primary biliary cirrhosis, hemochromatosis, and Wilson disease are not discussed. The poor endoscopic photographs are a notable drawback; most, but not all, are useful supplements to the text but the uniform lack of color and, in some cases, the poor quality, need correction. Many radiographic figures need arrows to assist the reader.
Gastroenterology
Gary L. Gitnick. New Hyde Park, New York: Medical Examination Publishing; 1985. $125.00.
This pocket-sized textbook attempts to summarize valuable clinical information in a concise format. Although the author is to be applauded for his efforts in compiling this information, the book suffers from the problems inherent in any single-author text. After a brief introduction to the approach to patients with gastrointestinal signs and symptoms, the author reviews the organ systems of the esophagus, stomach, small bowel, colon, and pancreas. Brief introductory sections on anatomy and physiology are followed by discussion of the most common disorders with an approach to diagnosis management and treatment. Algorithms and tables are sparingly used and only a few representative figures are provided.
In general, the text provides a no-nonsense, nuts and bolts, "take home" message for specific topics. However, the current edition is too dated to be used in its present format. For example, there are no discussions of omeprazole for reflux disease, the importance and treatment of Helicobacter pylori, or the use of metronidazole for Clostridium difficile diarrhea. Although most of the recommendations are reasonable, some, such as that which advises using ice water lavage for upper gastrointestinal hemorrhage and those in the discussion of staphylococcal pseudomembranous colitis, are clearly out-of-date. References date from the late 1970s and early 1980s. The new edition must be updated thoroughly to be of any value, and the addition of more algorithms and tables would make the text easier to use. If these deficiencies are corrected, this text could be a useful companion for the busy medical student or house officer, although the price seems excessive for the information provided.
So, what should you buy? For those interested in the definitive gastroenterology text, should it be Sleisenger and Fordtran or Yamada? The decision must be based on the specific needs of the reader. Clearly, Yamada emphasizes basic aspects of gastrointestinal physiology and disease and includes chapters devoted specifically to normal physiology based on organ system. In contrast, physiology for specific organs is addressed under each organ in Sleisenger and Fordtran. For example, a review of pancreatic secretion is found in the pancreas chapter in Sleisenger and Fordtran but appears in the section on gastrointestinal secretion in Yamada. Similarly, to review esophageal motility, one would look at the initial section under esophageal physiology in Yamada and at the section on the esophagus in Sleisenger and Fordtran. Those interested in reviewing a topic completely will frequently have to switch volumes when using Yamada: A review of esophageal cancer will involve reading the chapter on esophageal cancer in volume 1 and reviewing therapeutic endoscopic modalities in volume 2, a procedure both disjointed and laborious. When specific chapters dealing with the same issue were reviewed, the chapters in Yamada still retained a more basic flavor. When focusing on specific clinical aspects, the texts are similar. An example of the difference between the two texts is found when reviewing esophageal tumors: In Sleisenger and Fordtran, endoscopic ultrasonography is reviewed and depicted; in Yamada, flow cytometry in Barrett carcinoma is illustrated. In general, more figures and better-quality cartoons appear in Yamada. Sleisenger and Fordtran is more compact, readable, and user-friendly than Yamada, because all the information on a specific topic is located in each section. Both academic and clinical gastroenterologists alike will find that the Yamada text provides a comprehensive reference as well as initial sections dealing specifically with physiology of each organ system. The sections dealing with the approach to specific problems are excellent. If you buy Yamada, you really have to learn how to use it. Neither Yamada nor Sleisenger and Fordtran is an ideal source for those interested in liver disease.
For the medical student, house officer, and general internist in need of a rapid clinical overview, Clinical Gastroenterology would be a good buy. For the nongastroenterologist desiring a definitive gastroenterology text to turn to when needed, the clinical emphasis of Sleisenger and Fordtran would be useful, although the text probably provides more information than would be required. Given the style, the pragmatic approach, the outstanding quality of the figures, and the inclusion of liver diseases, Spiro is ideal for students or generalists dealing with gastroenterologic or hepatobiliary problems; gastroenterologists will also appreciate it. The time at which you purchase the text may also influence your decision: The most recently released text may be the most appropriate, given the lag time between advances in medical knowledge, writing, and publication.
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