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Doody's Review ServiceReviewer: Diana L. Rowell, MD (Ochsner Clinic)
Description: The new edition of Sleisenger and Fordtran's gastrointestinal pathophysiology textbook has undergone several remarkable changes which deserve consideration. First, the title testifies to the addition of 22 chapters on the liver. Dr. Fordtran (who wrote the foreword) did not edit this edition, but previous associate editors Mark Feldman and Bruce F. Scharschmidt join Marvin H. Sleisenger as co-editors. A new section on the approach to clinical problems covers the evaluation of nausea or diarrhea in a problem-oriented fashion, and is designed to appeal to clinicians in training. The subsequent order of presentation of organ pathophysiology is altered, with organs presented from cephalad to caudad, rather than hollow organs first. Despite these changes, the quality of the material, and the length of the text, remain unchanged.
Purpose: The purpose of this new edition is to provide a comprehensive and authoritative text on the pathophysiology, diagnosis, and management of gastrointestinal and liver diseases.
Audience: The intended, and suitable, audience for this edition is everyone from the medical student, resident, and fellow in internal medicine, surgery, or gastroenterology training, to the practicing internist or gastroenterologist. Although comprehensive, this edition is somewhat more user-friendly, with many concepts previously only referred to now included (e.g., APACHE and Ranson's criteria). For the fellow preparing for the gastroenterology boards, however, it remains a challenge to read several chapters at a sitting because of the density of information.
Features: Thirty contributors, including many world experts on liver disease, produced the new, comprehensive 400-page liver section. There are excellent chapters, as we have come to expect from this textbook, by such contributors as: Albert Czaja on autoimmune hepatitis, whose work is very clear and effectively illustrated; Bruce Runyon on ascites and spontaneous bacterial peritonitis, who includes comprehensive discussions of the physiology of ascites and a helpful algorithm for evaluating ascites; and Teresa Wright and Norah Terrault on viral hepatitis A through G. Geoffrey Farrell has delivered a "tour de force" chapter on drug-induced liver diseases. The liver section makes for a nice update for the practicing gastroenterologist, although it will also be useful for the clinician in training. Hepatologists and hepatology fellows, however, will need to turn to a hepatology textbook for more specific information. Other additions to the gastrointestinal diseases sections of the textbook include new chapters on nonsteroidal anti-inflammatory drugs and gastrointestinal disease by Byron Cryer, on Helicobacter pylori by Walter L. Peterson and David Y. Graham, and on GI complications of organ and bone marrow transplantation by Drs. Weisdorf and Payne.
Assessment: In order to accommodate the new material, some chapters were trimmed by 10-25 percent in length, and most reference sections were cut by 25-50 percent, with the emphasis placed on references after 1990. Despite these changes, approximately three chapters in four is contributed by one of the same authors as in the fifth edition. The new edition contains substantial new information, as all the chapters have been updated, without sacrificing the excellent coverage of hollow-organ pathophysiology which we have come to expect from Sleisenger and Fordtran.