Book Review

Gastrointestinal Bleeding

N Engl J Med 1993; 328:518-519February 18, 1993

Article

Gastrointestinal Bleeding
Edited by Choichi Sugawa, Bernard M. Schuman, and Charles E. Lucas. 564 pp., illustrated. New York, Igaku-Shoin, 1992. $138.50. ISBN: 0-89640-221-5

Advances in biotechnology during the past two or three decades have tremendously altered the ways in which physicians care for patients with gastrointestinal bleeding, and it is this premise that has motivated Sugawa, Schuman, and Lucas to develop a multiauthored textbook on the subject. They correctly emphasize that dramatic technical progress makes more important than ever an interdisciplinary, “team” approach that can be adequately served only by a broad-based, comprehensive book.

With nearly 50 clinically active, academically based physicians as authors, this book is unquestionably wide-ranging and detailed. The text describes bleeding from the alimentary canal in terms of its overall effect, its various clinical contexts, its sites of origin, and its diagnosis and treatment. When a single broad topic is discussed from several different vantage points, there is always the danger of excessive overlap and redundancy. In this case, however, the editors have been careful to minimize repetition. The chapter on liver disease in gastrointestinal bleeding, for example, focuses on how hepatic function affects bleeding and vice versa with only a minimal discussion of varices, whereas the chapter on bleeding from the esophagus leaves variceal bleeding entirely to six chapters devoted to that subject at the end of the book.

In a book about a highly technical subject, many readers will expect enough illustrations to make the subject matter clear. Each chapter in Gastrointestinal Bleeding contains some illustrative material, and the color plates in several chapters are superb. I suspect that the ample illustrations contribute to the relatively high cost of the book. In addition, the book is appropriately documented with references to the literature.

A textbook can only be as useful as its index permits, and the index of Gastrointestinal Bleeding passes muster with a reasonable degree of completeness and accuracy. When I looked up “zebras,” I was pleased to see that the index listed both duodenal and colonic varices. The term “hematobilia” was missing from the index, as it should have been, since I was unable to locate a discussion of bleeding from the hepatobiliary tree in the book.

Because the care of patients with gastrointestinal bleeding does indeed require an interdisciplinary approach, I would like to have seen a textbook on the subject integrate the relevant disciplines more aggressively. Among the authors of Gastrointestinal Bleeding, the necessary representation of endoscopists, surgeons, and radiologists is unquestionably provided. It is somewhat disappointing, though, that only 2 of the book's 34 chapters are jointly authored by representatives of different specialties. The chapters on bleeding in infants and children, on short-term management, and on diagnostic endoscopy in lower intestinal bleeding describe integrated approaches to management, but more complete descriptions of general approaches are available elsewhere. For example, Waye's article in the Mount Sinai Journal of Medicine (1984;51:491-500) provides a more comprehensive overview of the interdisciplinary management of lower intestinal bleeding than does his chapter in this book, which tends to focus on endoscopy.

Thus, the reader does not come away with a firm sense of an overall approach to the bleeding patient or of how the relevant subspecialties contribute to such an approach. Instead, the book offers a series of superb, yet somewhat narrowly focused, articles that provide in turn the viewpoints of the gastroenterologist, the surgeon, and the radiologist. Experienced clinical specialists and their trainees will find Gastrointestinal Bleeding the most valuable, for it is they who will most want to learn all they can about specific topics such as endoscopic coagulation therapy or transjugular intrahepatic portosystemic shunts. I suspect, however, that this book will be less appealing to generalists and to those beginning their clinical training.

Robert M. Donaldson, Jr., M.D.
Yale University School of Medicine, New Haven, CT 06510