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Gut. 2007 May; 56(5): 740.
PMCID: PMC1942125

Clinical Dilemmas in Inflammatory Bowel Disease

Reviewed by D P Jewell

Edited by P M Irving, D S Rampton, Fergus Shanahan. Published by Blackwell Publishing, Oxford, 2006, $59.95, pp 248. ISBN 978-1-4051-3377-7

Ulcerative colitis and Crohn's disease never cease to fascinate those of us whose professional life is continually marked by their heterogeneity, their complex aetiology and pathogenesis, and the management issues that frequently stretch clinical skills to the limit. For all of us, but especially perhaps for those in training, the rapid developments in genetics, mucosal immunology, new diagnostic techniques, new treatments, new surgical outcomes and improved outcomes are all tremendously exciting. Thus, weekly clinical meetings to discuss the problems of individual patients, especially in a multidisciplinary context, are always stimulating. This volume is based on such meetings held at St Bartholomew's and the Royal London Hospitals. It contains 64 short chapters contributed partly by those who would have taken part in these meetings and also by many national and international clinicians of repute. Inevitably, when so many topics are covered, the quality varies from chapter to chapter. Some are too brief, provide little new information or new insights, and are rather superficial. Others discuss important issues very well; I particularly enjoyed the chapter on managing inflammatory bowel disease in the context of hepatitis B and C, and the pithy and informed reviews on probiotics, heparin and the role of stress, which will be of value to all doctors (and surgeons) managing these diseases. I am sorry that surgical dilemmas are largely ignored (but there is a good account of pouch surgery for colitis not yet classified—the new term for indeterminate colitis). This omission perhaps detracts from the overall value of the book. Both diseases still require joint medical–surgical care for optimal outcome and it is vital that each appreciates the clinical advances, challenges and dilemmas of the other discipline.

That said, this volume will provide a useful synopsis and introduction to the literature for many of the problems that are encountered on a daily basis whether in the clinic or on the ward. For junior staff, electronic access to provide immediate access to information would be of great value.


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