Book Review

Inflammatory Bowel Disease: Clinical diagnosis and management

N Engl J Med 2000; 343:156July 13, 2000

Article

Inflammatory Bowel Disease: Clinical diagnosis and management
Edited by David Rampton. 455 pp., illustrated. London, Martin Dunitz, 2000. £65. ISBN: 1-85317-734-2

Just another book on inflammatory bowel disease? Certainly, the hardcover binding and the thick paper suggest a rather conventional, textbook approach. I was pleasantly surprised, however. This book aims to provide an evidence-based, up-to-date, and practical guide linking basic scientific data to the clinical approach, and it goes a long way toward achieving this goal. It is written primarily for trainees in medical and surgical gastroenterology but also for nurses specializing in inflammatory bowel disease. I suspect that senior gastroenterologists and others looking for information on a particular problem may well dip into it also.

The book has four sections, which cover causes and mechanisms, clinical features and diagnosis, management, and special management problems. It includes practical and useful sections on medical and surgical management and on problems in childhood and pregnancy. The overlap between the sections has been kept to a minimum. Most of the chapters detail all the data available, but sometimes all this information is not summarized in a comprehensive statement of opinion. Whether detailed tables on the incidence of ulcerative colitis and of Crohn's disease around the world are helpful is open to question, but it is difficult to compare the data, since there is no information about how these data were collected. It is therefore not surprising that later in the book, the incidence rates quoted differ from those in the tables. Pathogenesis, including the mucosal immune system and arachidonic acid metabolism, is well covered, although perhaps this is unnecessary in a book for trainees at this stage of their careers.

The effect of inflammatory bowel disease on quality of life is poorly recognized and often inadequately managed. Methods of formally scoring the quality of life are comprehensively reviewed, with advice on how these methods can help in clinical management. The chapter written by a patient on what it is like to live with inflammatory bowel disease is salutary reading for the physician. This patient recounts her fear, embarrassment, and frustration and problems coping in a society that is not always sympathetic to illness. She also recounts the joy of life after her colectomy and how she can now shop, walk, and carry out normal activities. Although this is just one case report, it does provide perspective on the problems that patients encounter. There is also a chapter on the lives of patients and their families within the community, with coverage of everyday problems involving relationships, education, and employment.

The presentation, natural history, and prognosis of inflammatory bowel disease are well covered, as is the differential diagnosis. However, as with all differential diagnoses, lists of every conceivable condition are not very helpful, although the author has tried to place some of them in clinical context. Algorithms are always useful, but here they illustrate the difficulty of formulating them, since there is some contradiction between two of them. In an algorithm for rectal bleeding, the column under “suspicious” (e.g., blood mixed with stool) leads straight to colonoscopy, whereas the algorithm for bloody diarrhea (if the patient is ill) indicates the need for some blood tests and an abdominal radiograph and then radiolabeled white-cell scanning or an instant barium enema. Although both approaches are correct in the appropriate clinical situations, it is difficult to ascertain this from these algorithms.

The chapter on histopathology is very useful and practical, taking the reader from the biopsy procedure and the processing of the biopsy specimens to the pathologist's opinions and conclusions. The author here stresses teamwork and ends by saying that “pathologists have a quality of output which is intimately related to the quality of information input.” This is also, of course, true for radiology. The chapter on radiologic imaging is excellent, with superb reproductions of x-ray films — clearly a result of the excellent quality of the paper used in the book. The fine features of aphthoid ulcers and dysplastic changes can easily be recognized, but some arrows or even line diagrams would have been helpful.

Parveen Kumar, M.D.
St. Bartholomew's and the Royal London School of Medicine and Dentistry, London E12 AD, United Kingdom