Book Review

Advanced Therapy of Inflammatory Bowel Disease

N Engl J Med 2001; 345:72-73July 5, 2001

Article

Advanced Therapy of Inflammatory Bowel Disease
By Theodore M. Bayless and Stephen B. Hanauer. 670 pp., illustrated. Hamilton, Ont., Canada, B.C. Decker, 2001. $129. ISBN: 1-55009-122-0

This book, the second edition of Current Management of Inflammatory Bowel Disease, first published in 1989, is devoted to the medical, surgical, and supportive treatment of patients with Crohn's disease and ulcerative colitis. It includes chapters on 138 topics, 48 of which are new. The contributors are experts who have written concise, analytic chapters in which they describe their own approaches to the relevant problems. An editor has commented briefly on many of the topics to call attention to other approaches or areas of interest, and a list of references and supplemental readings appears at the end of each chapter. The book comes with a CD-ROM containing all the material in the book.

This book is meant for specialists in digestive diseases with a particular interest in the management of inflammatory bowel disease and for specialists who are seeking opinions about new or controversial methods of treatment. Nonspecialists should also consult this book, however, because many of the topics are of general interest to gastroenterologists and internists. It could also be useful for medical students and trainees in gastroenterology or internal medicine.

The 11 sections of the book cover all treatments for inflammatory bowel disease, not only in adults but also in children. There are chapters on patient–physician interactions and, for pediatric patients, family–physician interactions. The authors stress that the patient should be the primary manager of his or her chronic disease and should be guided and coached by a physician to find the best therapeutic regimen. Collaboration between physicians and surgeons is also stressed as a guarantee of better care for patients. An example of such collaboration is the typical management of severe ulcerative colitis. The support services for patients described in the book (e.g., nurse advocates for patients with inflammatory bowel disease, the Crohn's and Colitis Foundation of America, and consultation about nutrition) are of great interest. Indeed, the chapter by Rood on lifestyle issues is remarkable, and I recommend reading it first.

The section on diagnostic methods is detailed; the contribution of transabdominal bowel sonography to clinical decision making is important, since this noninvasive method is valuable for diagnosis, for the detection of complications, and for follow-up in patients with inflammatory bowel disease. An example of a computer data base for patients with inflammatory bowel disease is given. Such a data-base system is indispensable, both at the individual level (the gastroenterologist) and the collective level (the referral center), and can facilitate progress in epidemiology, pathophysiology, and pharmacoeconomics. The digestive and extradigestive complications of inflammatory bowel disease are well covered, and the importance of the location of Crohn's disease (i.e., gastroduodenal, jejunoileal, or perianal) is analyzed.

The various classes of medical treatment for ulcerative colitis and Crohn's disease are also covered in detail. Sequential and combined therapy is emphasized, with special attention to the location and intensity of the disease, its responsiveness to steroids, the ratio of efficiency to side effects, the management of acute flares, and maintenance therapy.

Enteral and parenteral nutrition as alternatives to chemical treatment, especially in Crohn's disease, is discussed. The sections on the surgical management of ulcerative colitis and Crohn's disease describe procedures (particularly laparoscopically assisted bowel resection), long-term results, and support for patients who undergo ostomy and pouch surgery. Behavioral therapy, stress and pain management, and alternative methods of care (whose use is often motivated by patients' dissatisfaction) are also mentioned.

One may regret the absence of a chapter on future therapeutic approaches, such as gene therapy, or the fact that some topics (e.g., aminosalicylates, corticosteroids, immunomodulators, and anticytokines) are covered in more than one chapter, but these are minor criticisms of a book that is a vast source of information on the treatment of patients with inflammatory bowel disease.

Bruno L. Bonaz, M.D., Ph.D.
Grenoble School of Medicine and Hospital, 38043 Grenoble CEDEX 9, France
bruno.bonaz@ujf-grenoble.fr