Targets of treatment in chronic inflammatory bowel diseases: Edited by H. Herfarth, B. G. Feagan, U. R. Fölsch, J. Schölmerich, M. H. Vatn, and M. Zeitz. 272 pp. $165.00. Dordrecht, The Netherlands: Kluwer Academic Publishers, 2003. ISBN 0792387848. Web address for ordering: www.wkap.nl

Abstract

One might ask whether the gastroenterology community needs another book discussing the pathogenesis and therapy of Crohn’s disease and ulcerative colitis. However, Targets of Treatment in Chronic Inflammatory Bowel Diseases is not a comprehensive inflammatory bowel disease (IBD) text and was not intended to be such. Its scope is much more limited than many of the standard IBD texts, and the editors do not claim that this book should replace such texts in the libraries of gastroenterologists, surgeons, and scientists. In this book, the editors have put together a summary of the proceedings of an IBD symposium held in Freiberg, Germany in October 2002. That symposium was intended to discuss and explore potential new targets for the treatment of inflammatory bowel disease. The book’s intended audience includes both clinicians and basic scientists. The book begins with an interesting historical perspective provided by David Sachar. His paper, published in 1980 on the etiological theories of IBD, is reproduced with a preface in which he attempts to place the prevailing theories from the 1960s and 1970s into a present-day context. The subsequent chapters dealing with targets for new drug development, innate immunity, and mucosal defense and the role of the enteric flora in IBD pathogenesis are very good summaries of the current state of knowledge and provide a reasonable list of references that could serve as a starting point for scientists interested in the field. These chapters are then followed by several unique chapters that discuss the relative merits and drawbacks of various model systems used for the investigation of the immunopathogenesis of IBD and the potential usefulness of new therapies. These include animal models, cell culture systems, and models that assess the integrity of the mucosal barrier. Taken together, these chapters provide a good primer for the clinician wishing to become familiar with experimental model systems, but they may not be sufficiently detailed for scientists working in the field. In addition, the discussion of cell culture systems is mainly limited to the work being done in one laboratory with human intestinal epithelial cells and human macrophages. A broader perspective with the inclusion of T-cell experiments would have been appropriate. Although the main emphasis was the exploration of potential new therapeutic targets-right from the basic science of IBD to the clinical application of basic science breakthroughs-there are several chapters that do not fit within the stated objectives. In particular, the chapters on functional genomics of wound repair, management of intestinal strictures, IBD-associated arthropathies, and the role of MRI for assessing inflammatory activity seemed out of place. Several chapters were also devoted to a discussion of symptom or outcome-specific management of IBD-diarrhea, abdominal pain, quality of life, and avoidance of drug side effects. In most cases, these chapters ended up being more of a discussion of the pathogenesis of these symptoms rather than the role of anti-inflammatory or immunomodulator therapy in causing symptomatic improvement and the mechanism whereby such improvement occurs. Useful, however, was the presentation of a case for the symptomatic treatment of diarrhea using nonspecific antidiarrheals. Given the significant psychosocial impact of IBD, a discussion of antidepressant or anxiolytic therapy and the use of alternative non-pharmacologic forms of psychosocial support would have been appropriate in the chapters on quality of life, quality of care, and neuroendocrine-immune interactions. Overall, this book has many well-written, concise, and worthwhile chapters but as a whole it suffers from some degree of inconsistency in style and editing. The use of Tables and Figures often does not add to the text discussion. Despite the reservations outlined above, this book does have some chapters that are worth reading for both the basic scientist and the clinician. However, as a total package it falls short of its goal and would not necessarily be a “must-have” addition to the libraries of most individuals working in the field. Bottom Line: Misses the mark.