Pediatric Gastrointestinal Disease, Pathophysiology, Diagnosis, and Management, 3rd Edition. By Walker WA, Durie PR, Hamilton JR, Walker-Smith JA, Watkins JB; published by BC Decker, Philadelphia, 2000.
The third edition of the “bible” of gastrointestinal, pancreatic, and hepatic disease has been heavily revised, updated, and reduced to a single volume. Authorities in the field prepared most of the chapters; only two chapters have fellows as their primary authors. Because this edition was rushed to publication to be available for an international assembly of pediatric gastroenterologists, it is more up-to-date in regard to therapy and referencing than the average text.
There has been an extensive recruitment of new authors for each edition, so there is minimal rehash of personal bias in the evaluation of disease management. A refreshing blend of international authors brings a new perspective for readers. The multiple chapters on development of the gastrointestinal system have been condensed into an excellent introductory section of just 11 pages. More importantly, the chapter justifying the subspecialty has been dropped.
The organization of the book into sections on pathophysiology, clinical manifestations and management, diagnostic techniques, and principles of therapy makes this edition easier to use for casual readers, such as the general pediatrician, student, or nurse practitioner. It is clear that a great deal of effort was devoted to minimizing duplication of material, which was undoubtedly not an easy task in a text where separate sections address “management” and “therapy.” The depth of material covered varies from a slim 6 pages on gastroesophageal reflux to 38 pages on hepatic failure and pancreatitis.
For the trainee or the recertification-phobic full professor, the material is well organized, easily recovered, and generally definitive. The index is thorough and, in contrast to the last edition, complete. A CD-ROM is enclosed (attached to the inside front cover) for those who wish to retrieve material electronically. In the general text, many of the radiographs and photomicrographs have poor detail, although they are clearer in the diagnosis section because of better cropping and focus on the pathology.
Several chapters, including those on the mechanisms of inflammation and intestinal motility, have been greatly expanded as a result of scientific progress. The clinical bases are covered with excellent reviews of abdominal pain, emesis, intestinal polyps, inflammatory bowel disease, and cystic fibrosis. Although Helicobacter pylori infection is well covered, other peptic disorders such as gastroesophageal reflux disease receive little emphasis. One of the final chapters, on the medical perspective of complications after gastrointestinal surgery, is excellent and will be of great value to the general pediatrician and novice gastroenterologist. It devotes 11 pages to the complications of fundoplication; gastroesophageal reflux disease gets it due here. This cautionary chapter should be mandatory reading for the most junior surgical resident as well as his or her attending pediatric surgeon.
The chapters on liver disease read well and cover presenting symptoms, differential diagnoses, evaluation, and management. The progress in the understanding of genetic liver disease is well summarized, as is the role of liver transplantation. Pancreatic disease, often covered briefly in passing, receives full exposure here, with an excellent update on the genetics and management of cystic fibrosis. Although significant effort has been made to discuss the nutritional components of management for each disease entity, this book makes no pretense of being a textbook of nutrition. The chapters on nutritional assessment and enteral and parenteral nutrition are very thorough, although the chapters on diarrhea therapy and feeding disorders are cursory. There is no chapter devoted to the overview of failure to thrive. While there is an excellent review of the child with Munchausen syndrome by proxy, there is no chapter on the psychosocial issues of child and family coping with chronic disease.
In summary, the editors and authors of this third edition have produced a superb, focused, and thorough text, which can meet the needs of the general pediatrician as easily as those of the experienced pediatric gastroenterologist. The editors have trained this generation of practitioners well; now those in the next generation can teach as they continue to learn. This text is a “must-have” for the office, the library, and the briefcase en route to the recertification exam.