Infections of the Gastrointestinal Tract

Abstract

2nd Edition Blaser MJ, Smith PD, Ravdin JI et al, eds Lippincott, Williams and Wilkins, 2002 ISBN: 0-7817-2847-9; $170.00 Infections of the Gastrointestinal Tract is a comprehensive multi-authored text of over 1300 pages covering luminal infection of the mostly adult gastrointestinal tract excluding the liver and biliary tract. The text is logically organized into ten different sections (a total of 81 chapters) with the first three sections covering epidemiology, physiology, and pathogenesis; the next two sections covering gastrointestinal syndromes in immunocompetent and immunocompromised hosts; and section six covering gastric infections, the bulk of which is on H. pylori. The remainder of the book is composed of detailed discussions of various infectious agents in section 7 followed by diagnosis, therapy, and prevention and control. Infections of the Gastrointestinal Tr a c t is an infectious diseases textbook rather than a gastroenterology text with emphasis on infectious diseases—not surprising given that most of the authors and editors are infectious diseases specialists rather than gastroenterologists. Infections of the Gastrointestinal Tract is the only book a practicing gastroenterologist will ever need if he or she desires information on the bugs and drugs in the gut. For example, the chapter on Norwalk virus contained everything I ever wanted to know about the viral structure, genome (including a map of the capsid protein), and virulence of the organism. The chapter on Whipple’s disease was similarly detailed and comprehensive enough to prepare a fellow lecture on the subject. On the other hand many chapters present a relatively cursory discussion of clinical symptoms, something which I suppose is not unreasonable since most the viral infections cause self-limited diarrhea. Still the brief paragraph on Norwalk agent didn’t seem to paint a clear picture of the viral illness, something which many of my patients had seen on the six o’clock news and inquired about. In my opinion, the main deficiency of most of the chapters is the lack of clinical information about the infection relative to the detailed presentations on the laboratory findings of the infectious agents. Even the three chapters on H . pylori, although more inclusive about clinical presentation, seemed somewhat lacking. For example, the section on diagnosis did not mention the importance of prevalence on the accuracy of serology. Although the authors state that proton pump inhibitor therapy can cause false negative urea breath test and rapid urease test, no specific recommendations were given as to what to do with such patients. Finally most chapters only briefly mention the possible role of endoscopy in evaluating gastrointestinal infections. For example, the otherwise excellent chapter on C. difficile s t a t e d that endoscopy is rarely used for diagnosis; in my experience the reflexive reaction to inpatient diarrhea by most internists and surgeons is to order stool studies and a flexible sigmoidoscopy knowing that one can often get an endoscopy faster than a stool study. The chapters on H. pylori mentioned that multiple biopsies are often required for diagnosis but does not discuss where or how; for example in patients with recent antibiotic use, proton pump inhibitor use, and bleeding. In my opinion, Infections of the Gastro i n testinal Tract is an excellent reference resource for most practicing gastroenterologists who have questions about infectious organisms, especially about the laboratory aspects, but those looking for a comprehensive clinical discussion about the infection syndromes could probably obtain the same information from any gastroenterology textbook. John Lee. MD Irvine, CA