Book Review

Challenges in Inflammatory Bowel Disease

Inflammatory Bowel Disease and Familial Adenomatous Polyposis: Clinical Management and Patients' Quality of Life

N Engl J Med 2007; 356:1898-1899May 3, 2007

Article

Challenges in Inflammatory Bowel Disease
Second edition. Edited by Derek P. Jewell, Neil J. Mortensen, A. Hillary Steinhart, John H. Pemberton, and Bryan F. Warren. 400 pp., illustrated. Malden, MA, Blackwell, 2006. $129.95. ISBN: 978-1-4051-2234-4

Inflammatory Bowel Disease and Familial Adenomatous Polyposis: Clinical Management and Patients' Quality of Life
Edited by Gian Gaetano Delaini. 481 pp., illustrated. Milan, Springer-Verlag Italia, 2006. $259. ISBN: 978-88-470-0433-7

It was not the intention of the editors and authors of Challenges in Inflammatory Bowel Disease to produce yet another comprehensive book on inflammatory bowel disease, but instead to consider specific issues. The book's chapters are divided into five major sections: “Clues to Etiology and Pathogenesis,” “Diagnosis and Assessment,” “Management of Ulcerative Colitis,” “Management of Crohn's Disease,” and “Special Management Problems.”

Have the authors succeeded in their ambitious aims? On balance, the answer is a qualified yes. Indeed, many of the chapters — all written by recognized experts in their fields — contain important information. I particularly liked the chapters on microbial sensing, the role of appendectomy, and the management of refractory distal colitis. But the book also has substantial weaknesses. Only a few practical algorithms are provided. The illustrations are limited and in black and white. Most of the references are from 2004 or earlier, and a lot has happened in the field since then. There are some referencing errors as well as occasional overstatements — such as that the role of the Paneth cell provides a convincing explanation for the preponderance of Crohn's disease in the terminal ileum.

In my view, this book cannot be recommended for the general gastroenterologist or digestive surgeon because it lacks essential components. It will, however, be useful for trainees or specialists with an interest in inflammatory bowel disease or for scientists who want expert information on topics outside their own area. The editorial team is made up of world leaders in the study of inflammatory bowel disease, and the basic and clinical scientific information they present is of high quality.

Another book on a similar topic, Inflammatory Bowel Disease and Familial Adenomatous Polyposis, deals with the two diseases in its title, and there is an emphasis on surgery throughout the book that is not mentioned in the title or subtitle. Perhaps the theme of colorectal disease and surgery is the justification for linking the two diseases in one textbook. The foreword describes the book's three objectives: to review current methods of treatment, to discuss management of complications associated with these therapies, and to give an account of new therapies. The chapters are divided into four sections.

Photomicrograph Showing a Metaplastic Polyp in the Rectum.

The authors of the first section cover the role of magnetic resonance imaging. The second section is a discussion of inflammatory bowel disease and includes chapters on epidemiology, pathology, dysplasia, motility, extraintestinal and perianal manifestations, endoscopy, nutrition, quality of life, pregnancy and urogenital problems, therapies and various aspects of surgery, and bowel and liver transplantation.

The authors of the articles in the third section cover polyposis, including genetics, extracolonic manifestations, desmoid tumors, and various aspects of conventional and laparoscopic approaches. The description of the laparoscopic approach to familial adenomatous polyposis is detailed and well illustrated. Articles in the fourth section provide information on the psychological aspects of colitis, the interdisciplinary aspects of the management of inflammatory bowel disease and familial adenomatous polyposis, the role of ileoanal pouching in indeterminate colitis, the surgical management of emergencies, and rehabilitation.

This book reflects the authors' diagnostic and therapeutic expertise. Discussions are up to date, and current topics are well referenced. However, there is excessive redundancy. Despite the number of appropriate algorithms that are included, this book does not feature enough pathophysiology or basic science to justify recommending it to gastroenterologists. The strength of the book is surgical technique and outcome, and for this reason I recommend it for surgeons in training and in clinical practice — but readers will have to search for the surgical “pearls.”

G.N.J. Tytgat, M.D., Ph.D.
Academic Medical Center, 1105 AZ Amsterdam, the Netherlands