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Gut. 2007 October; 56(10): 1488.
PMCID: PMC2000283

Immunology and diseases of the gut

Reviewed by Allan M Mowat

Edited by T T MacDonald, A C Bateman. London: Remedica, 2006, £20.00 (softcover), pp 179. ISBN 1-901346-56-0.

Gastroenterologists (and other clinical specialists) complain that immunology is conceptually opaque, overcomplicated and obsessed with acronyms and unnecessary jargon. As a result, any message it may have for understanding disease is hidden and/or ignored. Immunologists on the other hand, are frustrated by what they see as lazy and superficial attempts to try to understand a topic they find to be unimaginably clear and relevant. Often, there is little or no significant communication between the disciplines, meaning that important opportunities for improving diagnosis and treatment are lost. This is a major loss to 21st‐century medicine and to gastroenterology in particular, in which, as the authors of this book point out, many of the most important conditions have an immunological basis. Unfortunately, this issue is not likely to improve in the foreseeable future. Academic gastroenterologists are increasingly a threatened species in many countries, not least in the UK, and most medical schools no longer devote significant time to basic subjects such as immunology. Thus junior clinicians do not have the building blocks to pick up a new area easily if the opportunity does arise for research.

Aimed principally at practising clinicians and pathologists, this book attempts to address at least the result of some of these problems, by providing basic information on the workings of the immune system and relating this to intestinal disease. It is designed to be read from a background of little or no previous knowledge, and the authors are an excellent mix to perform the task. Tom MacDonald is an eminent mucosal immunologist and has published extensively on several of the diseases discussed in the book. Adrian Bateman is an experienced histopathologist with a special interest in gastrointestinal (GI) disease, and adds a solid grounding in the systematic assessment of immunopathology and in basic mechanisms of pathogenesis, again topics to which current medical school curricula now pay little heed.

The volume itself is relatively short (<200 pages) and can be read as one entity or in parts. The “meat” of the book is a list of individual GI diseases in alphabetical order and covering everything from infectious disease to immunodeficiency and cancer. Each of these comprises short sections addressing topics such as genetic basis, diagnosis, treatment and other issues of direct clinical relevance, as well as a brief overview of the immunopathology. These are generally excellent, although in places, they do seem to assume a reasonable knowledge of systematic pathology. They could also have discussed the immunological aspects rather more directly related to the earlier sections on the immune system, rather than from the pathologist's viewpoint. A brief glossary of terms at the end of the book provides cross‐referenced definitions of most of the important immunological terms and some clinical ones. These are essential components of books of this kind and here have been carefully chosen, allowing even the first‐time reader to find a path quickly round the inevitable abbreviations and specialist terms.

The first parts of the book give an introduction to basic immunology, followed by a more in‐depth discussion of the special features of the intestinal immune system. These sections take the reader from fundamental concepts, through the mechanisms of immune function in a concise and always readable manner. They should be readily accessible to the target audience and will also be useful for medical students, or anyone else looking for a quick revision of the most important issues.

Inevitably with such an approach, there are omissions and some oversimplifications, although these are mostly minor. Some of these include the definition of an antigen and the differences between adaptive and innate immunity, topics that are great sources of confusion to the novice and are important when considering the causes and treatment of inflammation. In this respect, it is also surprising that the new ideas on the role of the innate immune response in coeliac disease are not mentioned. Another topic that warranted more attention is the role of major histocompatibility complex genes as disease markers, given the strong association between several of the GI diseases discussed and individual human leucocyte antigen haplotypes. These are described in the sections on disease, but not explained fully. There is also no direct discussion of dendritic cells as the crucial antigen presenting cells. Finally, it is probably unlikely that the readers of this book will appreciate fully the discussion on whether humans are immunologically tolerant to food proteins and commensal bacteria. This is a controversial topic, and not all mucosal immunologists would agree with the authors' conclusions here.

In summary, this excellent newcomer fills an important gap in the market and will be of use to a wide variety of readers.


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