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Gut. 2007 October; 56(10): 1487–1488.
PMCID: PMC2000246

Clinical nutrition in gastrointestinal disease

Reviewed by Julian R F Walters

Edited by Alan L Buchman. SLACK Incorporated: New Jersey, 2006, $134.95 (hardback), pp 674. ISBN 1-55642-697-6

The involvement of the gastrointestinal system in ensuring adequate nutrition is fundamental, yet there have been remarkably few books aimed at providing education in clinical nutrition to gastroenterologists. Dr Buchman deserves congratulation for his vision in putting together this book, which provides a thorough reference in how gastrointestinal disease affects nutritional status, how nutritional status affects disease processes, and how the most appropriate nutritional interventions can lead to improved outcomes.

There are 53 well‐chosen chapters, written by contributors who are almost all North American physicians, with a number of nutritional scientists and dietitians as co‐authors. Sections cover nutritional assessment, general nutrition, nutrition in gastrointestinal disease and critical care, the management of intestinal failure, nutritional support and finally, obesity. The various chapters seem to be appropriately balanced to meet the requirements of physicians who want to learn about, or update their knowledge, of nutrition. The relevance to clinical practice is clear throughout, yet there is enough basic background to serve as a resource for teaching and intellectual inquiry. Chapters on malabsorption and specific gastrointestinal diseases written from a nutritional point of view exceed what is usually found in dietetic or gastroenterology textbooks. Interesting contributions include those on prebiotics and probiotics, and surprisingly, the addition, in the one on food and water safety, of the potential for bioterrorist attack, a situation none of us hopes to encounter. This book omits broader discussion of the politics of food and malnutrition.

Intestinal failure and nutritional support are covered in detail, with good reviews of options for short‐bowel syndrome and adult and paediatric enteral and parenteral feeding. In general, this book addresses well the areas of interest to gastroenterologists, but there could have been more detail on complications of percutaneous endoscopic gastrostomy and other enteral tubes, and on prevention of the refeeding syndrome. Medical, legal and ethical aspects of nutritional support are discussed well.

Obesity is becoming the most important nutritional problem we face as gastroenterologists, but until the role of the gastrointestinal tract in the regulation of food intake has been clarified, much of our involvement will be interactions with patients who have had bariatric surgery. These topics are addressed at the end of this book.

The book is easy to read, with frequent use of tables and black and white figures. References are numerous but, as it inevitable with compilations such as this, they miss out on the more recent findings. This book is likely to run to further editions and it may be possible to achieve a faster time to publication. It is, however, an important new resource for all gastroenterologists in training and in practice. It should find a place in the offices of all involved in luminal gastroenterology, and enable the understanding and the advancement of clinical nutrition, with benefits to our patients.

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