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Gastroesophageal Reflux Disease

J. Waring
Published 2001 ·

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This handbook is from a series entitled Fastfacts, which are self-labeled “indispensible guides to clinical practice.” The publishers produce a new title each month with particular emphasis on conciseness and practicality. The series has the lofty goal to cover the entirety of medicine by 2002. This particular edition is written by two acknowledged international investigators in the field of celiac disease. This is an especially useful reference because, to my knowledge, there are no similarly formatted handbooks on this topic. This short handbook fulfills its admittedly narrow mission quite well. It is divided into chapters covering the standard topics including definition, epidemiology, pathophysiology, clinical manifestations, diagnosis, complications, management, dermatitis herpetiformis, and future trends. Both adult and pediatric forms of celiac disease are included. The chapter pages are color coded with the table of contents on the cover, so the reader does not even have to open the book to find the area of interest. The chapters themselves are short with an extremely viewer-friendly layout. There are an abundance of color-coded tables, figures, radiographs, and photographs, which are reproduced exquisitely. Despite the brevity of the book, most if not all of the important issues are at least mentioned with some consensus statement as to the latest recommendations even if they are just the authors’ expert opinions. Many parts of the work are particularly well done. The chapter on definitions lays an important groundwork for the rest of the book and at least attempts to clarify some of the confusion both among primary care and specialist physicians as to the specific manifestations of celiac disease. The definitions cover typical, atypical, silent, potential, and latent celiac disease. The figures and tables are easily interpretable and add to the text instead of just reiterating it. By far, the best feature of the handbook is the authors’ blending of the published data on the diagnosis and management of celiac disease with what can and should be done realistically in the clinical setting. For example, they appropriately state that in clinical practice follow-up biopsies demonstrating continued abnormal mucosa may suggest dietary noncompliance, but rarely change the diagnosis. In addition, they address the controversies about the exclusion of oats and the protracted ingestion of small amounts of gluten and give reasonable clinical recommendations in the admitted absence of data to support them. It is fairly easy to find fault with any reference on this subject that is only 78-handbook-sized pages long. Obviously, a staggering amount of information must be left out. However, for the purposes of this text, I feel most of the omissions are appropriate and even desired. The most notable deficiency is the lack of any clinical algorithms, which are almost standard in this type of publication. Algorithms for the diagnosis and management of typical and refractory disease would have been useful. The chapter on pathophysiology leaves much that a practicing gastroenterologist would need to know for a board examination, but is clearly enough as a quick reference while in clinic. Also, despite generally useful photos of clinical manifestations of celiac disease, there are no photos of endoscopic findings and no r commendations on the number of small bowel biopsies to be taken. Although osteomalacia and osteopenia are discussed in the sections on clinical manifestations and complications, there is no recommendation to obtain bone scans in these patients. The sensitivity of anti-endomysial antibodies is also overstated as 90–100%, when some studies have found much lower sensitivities. Finally, although published in 2000, there are only two sentences devoted to the use of tissue transglutaminase antibody tests. Overall, I would recommend this book as a handy quick reference to the practicing clinician who sees patients with celiac disease. It will not be able to function as the only reference in the clinician’s library; however, it fulfills its stated goal to be a “highly practical and refreshingly concise guide” to the busy practicing clinician. The intended audience is not clearly gastroenterologists, but most would benefit from the information summarized in this volume. If you don’t believe me, this is one of the few texts evaluated here that can be easily reviewed personally.
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