Book Review

Helicobacter pylori in Peptic Ulceration and Gastritis

N Engl J Med 1993; 328:520February 18, 1993

Article

Helicobacter pylori in Peptic Ulceration and Gastritis
Edited by Barry J. Marshall, Richard W. McCallum, and Richard L. Guerrant. 226 pp., illustrated. Boston, Blackwell Scientific, 1991. $59.95. ISBN: 0-86542-108-0

One of the most exciting recent advances in gastroenterology has been the elucidation of the role of a novel spiral bacterium in peptic ulcer disease and gastritis. The organism, now known as Helicobacter pylori, has caused us to reexamine our understanding of and therapeutic approach to these diseases. Because the original work was carried out by Dr. Barry Marshall and his coworkers, it is appropriate and timely that Dr. Marshall, Dr. McCallum, and Dr. Guerrant have organized a book that reviews this important subject. Their book covers many areas, ranging from basic science and clinical research to the diagnosis and treatment of H. pylori. The individual chapters are accurate and appropriately balanced in presentation, and they will prove extremely useful to any academician or practitioner interested in learning more about this interesting organism and its possible role in human disease. This book will be particularly valuable as a reference tool for the subspecialist in gastrointestinal diseases. It will also be of use to the internist, general practitioner, pathologist, microbiologist, and gastrointestinal surgeon. In addition, many chapters will prove to be valuable for the clinical and basic researcher interested in understanding the most recent developments in this area.

The first three chapters, which cover the classification of gastritis, the taxonomic and microbiologic characteristics of H. pylori, and the clinical entity of non-ulcer dyspepsia, are well written. The chapters on the epidemiologic features of H. pylori infection, animal models of H. pylori gastritis, and microbial adhesions and toxins that interact with the gastrointestinal mucosa provide interesting reading. They discuss many exciting advances in the studies of the organism. It is clear from these three chapters that a great deal of knowledge has been gained, but many intriguing and important questions remain to be answered.

The chapters on laboratory diagnosis and on the immunologic and molecular-biologic features of H. pylori provide useful information for clinical laboratories. These chapters on practical matters will be of value for the clinical investigator and the microbiologist. For the gastroenterologist, the chapters that discuss randomized controlled trials of peptic ulcer therapy, the relation of H. pylori to duodenal ulcer, and the diagnosis and treatment of H. pylori will be particularly useful. They are important reference sources, and they provide practical suggestions for dealing with a number of common questions about H. pylori.

The two chapters by Dr. Marshall on the diagnosis and treatment of H. pylori are particularly well written and demonstrate his extensive clinical experience in treating patients with this pathogen. The final chapters on the relation of nausea and vomiting to H. pylori, the pharmacologic features of colloidal bismuth subcitrate, and pediatric H. pylori infection represent three important clinical areas.

The only area that is not discussed in great detail, but that has received a great deal of recent attention, is the relation between H. pylori and gastric cancer. At the moment there is inadequate information about this topic, but future editions of this book may provide an appropriate review.

Overall, I found this book easy to read, with excellent figures and tables. It provides a complete discussion, using succinct summaries, of the theoretical and practical knowledge needed to understand H. pylori and its role in human disease. I would therefore recommend the book very highly as an outstanding contribution to the gastroenterology literature.

Richard P. MacDermott, M.D.
University of Pennsylvania School of Medicine, Philadelphia, PA 19104