Book Review

Medical Management of Liver Disease

N Engl J Med 2000; 342:827March 16, 2000

Article

Medical Management of Liver Disease
Edited by Edward L. Krawitt. 636 pp., illustrated. New York, Marcel Dekker, 1999. $185. ISBN: 0-8247-1968-9

Knowledge of liver disease has increased enormously in the past few years and has changed both the diagnosis and the treatment of hepatic disorders. Medical treatments of viral hepatitis and portal hypertension are among the important advances of the past decade in this field. This progress clearly justifies the publication of Medical Management of Liver Disease, and the editor is to be congratulated on his initiative.

The book has 10 parts, which are divided into a total of 44 chapters written by experts who are mainly from the United States but also from Canada, Brazil, France, Germany, and Denmark. All the chapters include an up-to-date introduction on the pathogenesis of the condition under discussion as well as full coverage of diagnosis and therapy. The first part, which contains four chapters, is devoted to the treatment of patients with high serum liver-enzyme levels, abnormal imaging findings, jaundice, and abnormal results on virologic tests. It will be especially interesting to general practitioners. The second part, which includes six chapters, deals with viral hepatitis and its management. The third part includes four chapters dedicated to autoimmune liver disease. The other parts of the book focus on alcoholic liver disease (2 chapters), gallstones (2 chapters), liver infections (3 chapters), hepatobiliary neoplasms (2 chapters), complications of liver disease, such as portal hypertension and encephalopathy (9 chapters), the care of patients before and after liver transplantation (2 chapters), and other hepatopathies, such as metabolic and congenital liver disease and fulminant liver failure (10 chapters).

In addition to liver diseases that clinicians see often and that are best known by internists and gastroenterologists, such as chronic viral hepatitis or alcoholic liver disease, the book also covers subjects not usually discussed in textbooks or reviews. These include the management of cryoglobulinemia related to hepatitis C virus infection, overlap syndromes, chronic liver disease (including nutritional support), cirrhotic cardiomyopathy, nonalcoholic steatohepatitis, granulomatous hepatitis, and parasitic liver disease, which is covered in depth.

All the chapters include tables, algorithms, and black-and-white figures. Works included in the bibliographies, which are up to date, are of a general type, and the references are not cited in the text. As a result, sometimes the discussion reflects an author's own opinion rather than an established fact. There is some irregularity in emphasis among the chapters, to the point that a common problem such as the management of chronic hepatitis C is covered in only 15 pages, whereas primary sclerosing cholangitis, a much less common entity, is covered in 16 pages.

The book has some minor defects. Examples are the absence of the latest data on the use of interferon and ribavirin combination therapy in the management of chronic hepatitis C and the lack of any mention of the role of nitrates and beta-blockers for secondary prophylaxis against variceal bleeding and the role of nitric oxide in the pathogenesis of cirrhotic cardiomyopathy. In the chapter on pulmonary complications of liver disease, the hepatopulmonary syndrome is covered in depth, but pulmonary hypertension is not. These pulmonary complications of chronic liver disease are equally common and are very important in the evaluation of patients for liver transplantation. A chapter on the use of pharmacologic agents by patients with cirrhosis would have been an interesting addition to the book.

Altogether, I found this book an excellent and useful review of the diagnosis and treatment of liver disease, one that contains information not found in any other book published thus far. This book covers almost all aspects of the medical management of liver disease in a brief but complete manner. It will be especially interesting to internists and gastroenterologists.

Jaime Guardia, M.D.
Hospital General Universitari Vall d'Hebron, Barcelona 08035, Spain