Book Review

Gastrointestinal Pharmacology & Therapeutics

N Engl J Med 1997; 337:1639November 27, 1997

Article

Gastrointestinal Pharmacology & Therapeutics
Edited by Gerald Friedman, Eugene D. Jacobsen, and Richard W. McCallum. 780 pp., illustrated. Philadelphia, Lippincott–Raven, 1997. $159. ISBN: 0-397-51625-8

The rapid evolution of the pharmacologic treatment of gastrointestinal, hepatic, and pancreatic disorders makes it difficult for practitioners to quickly find comprehensive, up-to-date, well-referenced information on the treatment of all these conditions. This textbook not only supplies the data but also starts every chapter with a well-written discussion of the pathophysiology and pharmacologic principles on which the therapy is based.

New insights into the cause and pathophysiology of disorders may completely alter therapy. A provocative example is the discovery of the role of Helicobacter pylori in peptic ulcer disease. Treatment of peptic ulcers with acid suppression without eradication of H. pylori must now be considered inadequate, because today cure is the main aim of treatment. The chapter on the role of H. pylori will therefore be greatly appreciated, but the discussion of eradication of the organism by treatment is rather limited. Moreover, a discussion of the progress of vaccination against H. pylori, which should have an enormous impact on health worldwide, is lacking. Another example of important new developments is the role of various cytokines in the pathogenesis of inflammatory bowel disease. This knowledge has led to new, promising treatment for these conditions with cytokines and anticytokines, although treatment of the cause (or causes) of the disease is not in hand. This textbook reports on the first steps taken in the development of this form of immunomodulatory treatment.

A very useful chapter for clinicians covers the gastrointestinal complications of the acquired immunodeficiency syndrome (AIDS). Many nonpathogenic microorganisms cause severe gastrointestinal morbidity and general wasting in patients with AIDS, and careful management of these complications is mandatory.

I have some criticisms to make, however. Generally, overviews of medical therapies for any condition suffer from the fact that negative findings tend not to be published early. This may cause discrepancies between the effects observed in practice and the outcomes reported in clinical trials. In some chapters, the results of several meta-analyses are reported, but they have to be interpreted with caution. Although the book may serve as a guide, in most chapters guidelines for the stepwise approach to the problem patient are lacking. It is also disturbing that therapies that have become obsolete because of newer developments are widely discussed — e.g., histamine H₂-blockers for chronic acid suppression in the Zollinger–Ellison syndrome in the era of the proton-pump inhibitors.

Paul Rutgeerts, M.D., Ph.D.
University Hospital, B-3000 Leuven, Belgium