Book Review

Abstract

Has the therapeutic divide across the Atlantic disappeared? My first thought when asked to review the book, Fast Facts: Inflammatory Bowel Disease, written by two well known experts on inflammatory bowel disease (IBD), was that there would be major differences in approach to this group of patients particularly in the field of therapeutics across the Atlantic. This had been my impression during my gastroenterology training, oh too many years ago. I have learned by reviewing this book that the approach in Ireland and the United Kingdom mirrors the practice in most of Canada. I can endorse this book for a large number of groups. It is an up-to-date synopsis suitable as a reference for family physicians, emergency room physicians, general internists and medical students. It also would serve well as the earliest reference for training residents in gastroenterology and surgery before they expand their knowledge on this subject. It would be a valuable resource for allied health professionals assisting in the care of these patients such as dieticians, social workers, nurses and enterostomal therapists. It is not meant to be a reference for specialists in this field. Some patients might be comfortable with this as a disease reference. This small book (135 pages) covers the topic in surprising depth. It is a revised and updated edition which is reflected in its polished presentation. The topics are well separated into discussions of etiology and pathogenesis, clinical, presentation and complications, and diagnosis. This is followed by discussions on investigations and treatments, which has been wisely separated into Crohn’s disease and ulcerative colitis. It then ends with chapters on surgery, IBD in pregnancy and children, prognosis and future trends. The chapter on medications outlines all the current therapies, including their suspected mechanism of action, adverse events, formulations and indications, and contraindications. As with most chapters, the information is presented in tabulation format and longer format, so each item is reviewed twice to assist in retention of information. There is a brief discussion on future promising therapies and the use of alternative treatments. The chapter on diagnosis separates out the differential diagnosis based on presenting symptoms such as bloody diarrhea, abdominal pain with diarrhea and weight loss, rectal bleeding, abdominal mass and pain. This approach will certainly be helpful for the target audience. All these areas are well covered, with strong use of pathology images and endoscopic images, diagrams and tables. Each chapter ends with a list of suggested readings and a summary of the key points which help reinforce items learned for those reading the entire chapter. The book has been well indexed to allow for use as a reference book. It also provides contact information for Crohn’s and colitis foundations in many countries across the world, including Web sites. Other informative Web site addresses are provided. I was particularly impressed by the fact that this book, published in January 2006, has remained current in the rapidly changing field of therapeutics. Of note is the description of the use of infliximab in ulcerative colitis. As expected there were a few cross-Atlantic differences, such as the spelling of cyclosporine (ciclosprine) and the use of balsalazide and paracetamol. There are also references to tests not routinely available in Canada such as SeCHAT scans, capsule endoscopy, serology testing (ANCA and ASCA) and stool calprotectin. A major weakness for those wishing to expand their knowledge is that references in each chapter often do not refer to the original articles but often textbook chapters and review articles. The bottom line without fistulas: A valuable resource for practioners (nongastroenterologists) who are involved in the management of patients with IBD.