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Gut. 2007 August; 56(8): 1175.
PMCID: PMC1955520

Sleisenger and Fordtran's Gastrointestinal and Liver Disease

Reviewed by David H Adams

Edited by Mark Feldman, Lawrence S Friedman, Lawrence J Brandt. Philadelphia: Saunders Elsevier, 2006, £180 (hardback), pp 1–1540 and 1541–2890. ISBN 1-4160-0245-6

The 8th edition of this famous textbook is the first not to be edited by either of the original editors and the 3rd edition to include hepatology as well as gastroenterology, with 38 of the 124 chapters focused on liver and biliary disease. This book thus provides a comprehensive reference for general gastroenterologists as well as more specialised practitioners in gastroenterology and hepatology. The two volumes are presented in a modern glossy style with clear figures and plenty of high‐quality line drawings and tables which make the individual chapters easy to read.

The first section on basic biology is relatively brief, but this is supplemented by introductions to the subsequent sections that include anatomical, embryological and developmental aspects for each organ. The book is multi‐authored with 177 contributors, and the editors have done well to maintain a high general standard and a relatively uniform style. The book is dominated by North American contributors (154 out of 177) and, although this is understandable given the origins of the book in the USA, it is perhaps a shame that a more international authorship was not used.

There are several new chapters covering, for instance, gastrointestinal stromal tumours and eosinophilic disorders, plus expanded information on obesity and nutrition and a new section on psychosocial aspects. This latter section is particularly welcome in a gastroenterology textbook, given that so many patients present with symptoms that may reflect underlying psychosocial problems rather than established disease processes. On the whole, this section is thought‐provoking and useful in outlining some alternative approaches to deal with difficult patients including an excellent section on palliative care. However, it is important to maintain scientific rigour in assessing alternative therapies. In several places in chapter 25, papers giving results of homeopathy trials are referred to as either showing a trend to improvement or highlight individual small studies, the results of which were not borne out by larger studies or meta‐analysis. Reporting weak or defective clinical trials is rightly considered unacceptable in other areas of medicine and the same rigour should apply to alternative therapies, particularly in the case of homeopathy where there is no scientific rationale for its action. Homeopathy has some powerful advocates, especially celebrities who give it a veneer of respectability which its lack of scientific integrity does not warrant. We must be careful as scientists that we do not inadvertently add to this by making ambiguous or conciliatory statements about studies that lack scientific rigour. To the authors' credit, they have added a section at the end of the chapter stating the importance of proper safety monitoring and regulation of complementary and alternative medicines and emphasising the enormous amounts of money involved in this lucrative market.

Elsewhere in the book there are a few idiosyncrasies in layout; for instance, primary sclerosing cholangitis is in volume 1 under biliary tract whereas primary biliary cirrhosis and autoimmune hepatitis are in volume 2 under liver, but for the most part the layout is clear and easy to follow.

One of the problems with textbooks is keeping up to date. An example of this is the omission of any reference to chemokines from the index and the use of outdated terminology when referring to chemokines in the section on mucosal immunity and lymphocyte trafficking to the gut. This emphasises the fact that textbooks are best used to reference clinical information and the established basis for disease rather than as cutting edge reviews of current scientific thinking. This brings up the conundrum of whether textbooks are still required when instantly updated information is readily available via the internet and when even a general facility such as Wikipedia contains increasingly sophisticated and comprehensive entries under medical and scientific subjects. If you haven't used Wikipedia before, look up coeliac disease for an example of the excellent quality of information available (http://en.wikipedia.org/wiki/Coeliac_disease). However, even superficial dipping into this book reveals a wealth of information which is not readily accessible elsewhere, which shows that although very few of us read such books from cover to cover, there is still a place for the well‐written comprehensive textbook that can be consulted on encountering a difficult clinical problem or—more frequently these days in my case—a lapse in memory.

The quality of the latest version of this famous textbook makes it an ideal choice for the clinician who needs a comprehensive reference book covering all the important areas in clinical gastroenterology and hepatology.


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