Book Review

Infections of the Gastrointestinal Tract

N Engl J Med 1996; 334:805March 21, 1996

Article

Infections of the Gastrointestinal Tract
Edited by Martin J. Blaser, Phillip D. Smith, Jonathan I. Ravdin, Harry B. Greenberg, and Richard L. Guerrant. 1578 pp., illustrated. New York, Raven Press, 1995. $245. ISBN: 0-7817-0226-7

The stated goal of this large textbook is “to provide a comprehensive source that combines the scientific basis and the art of medicine, relevant to enteric infections.” To accomplish this goal, the editors enlisted a diverse group of authorities to write the 97 chapters in the book. The editors' goal is difficult to achieve, because they attempt to combine art and science and aim at a diverse group of readers. The needs of someone like me, a gastroenterologist interested in patient care and teaching, differ from those of pediatricians, surgeons, and infectious-disease specialists, as well as public health practitioners and those practicing in developing countries. Another important need in this era of AIDS is to recognize explicitly the special aspects of infections in immunocompromised patients. The editors have organized this book in a way that addresses most of these needs.

The book has 10 parts. Part 1 includes an interesting historical background and two chapters on the epidemiology of diarrheal disease in developing and developed countries. Each of these chapters provides an excellent overview. Parts 2 and 3 present the basic principles of gastrointestinal anatomy, physiology, and immunology. The chapters have been written by expert investigators, are quite readable, and include clear illustrations. Part 4 covers clinical syndromes and emphasizes the presentation of diseases, with chapters on food poisoning, acute watery diarrhea, acute inflammatory diarrhea, traveler's diarrhea, and idiopathic chronic diarrhea, as well as specific diagnoses such as tropical sprue, bacterial overgrowth, appendicitis, diverticulitis, and peritonitis in intraabdominal abscess; there is also a chapter on microbial agents in inflammatory bowel disease. These well-written chapters are designed to be independent presentations. They are authoritative, with a clear emphasis on the art of medicine. Recommendations for the appropriate use of diagnostic techniques are thoughtful and take into consideration the costs and benefits of establishing a specific etiologic diagnosis. Where diagnostic algorithms are presented, they are clear and easily followed.

Part 5 discusses the clinical approach to gastrointestinal syndromes in immunocompromised hosts. The chapters are comprehensive and well written, but they do not address the art of medicine in the same way as the previous chapters do. Diagnostic strategies are not addressed in terms of cost efficiency or appropriateness. Although the task might have been daunting, I was disappointed that no attempt was made to address the appropriateness of endoscopic diagnostic evaluation in various presentations of human immunodeficiency virus (HIV) infection. There is a separate chapter on the role of endoscopy in the evaluation of gastrointestinal infections, but it does not address this issue either. Part 6 discusses Helicobacter pylori. All the chapters are up to date and well written, but there is excessive repetition between the chapter on natural history and the chapter on clinical approaches, since each syndrome associated with H. pylori is reviewed in both chapters. Part 7 consists of 38 chapters on individual organisms. These similarly organized chapters cover microbiology, epidemiology, pathophysiology, and approaches to diagnosis and therapy. The last three sections of the book cover diagnostic approaches, therapy with antibiotics and other agents, and prevention through vaccination and other means. The chapters on endoscopy and radiology are comprehensive and well illustrated but do not address the question of which type of study is most appropriate in a given clinical context.

I found the book's organization to be one of its major strengths. Since each chapter is designed to be read independently, the book serves as an excellent reference work. however, this approach necessitated addressing similar information in the chapters on clinical presentation and in later chapters on specific organisms, with the risk of disagreements among authors or even contradictions between chapters. I diligently searched for such contradictions but found only differences in emphasis. In many cases, later chapters on specific organisms clarify issues discussed in prior chapters and are therefore complementary. The chapters on organisms are comprehensive and useful. Some of the chapters on the approach to clinical syndromes and the overviews are very insightful and exciting in their analysis and approach. By including chapters that present various perspectives, the editors have been successful in their goal of appealing to a diverse readership. Although the book would have benefited from a discussion of an efficient and cost-effective approach to the diagnosis of gastrointestinal infections in patients with HIV infection, it is still useful for clinicians providing care to such patients.

Most infectious-disease specialists will probably want to own this book. It is not a “must buy” for all practicing gastroenterologists, but they would certainly benefit from having access to it. I am glad to have it on my shelf.

Peter F. Ells, M.D.
SUNY at Stony Brook, Stony Brook, NY 11794-8173