| Overall rating: | Good to excellent |
| Strengths: | Comprehensive, understandable, honest and up to date |
| Weaknesses: | Surgical therapy section too detailed and inclusive; quality-of-life table presented without explanation of how to score it; tone occasionally patronizing |
| Audience: | Patients with inflammatory bowel disease and their families; local and school libraries; school teachers with affected students |
The book uses easily understood vocabulary and explanations. It can serve both as a reference book and as a comprehensive review.
After an introduction to gastrointestinal anatomy and function, there is a chapter on epidemiologic aspects of IBD and on theories concerning its causes, including genetic associations. Wherever possible Canadian data are presented. Certain controversies, such as the relation of IBD to stress or lactose intolerance, are highlighted, as are important topics such as corticosteroid therapy.
Saibil's approach to diet and nutrition have a positive emphasis and are not influenced by the myriad of unproved, untested, anecdotal diets and diet books. The importance of adequate nutritional support in young, growing patients is emphasized.
Drug therapy with 5-aminosalicylate, steroids, antibiotics and immunosuppressive agents is well covered. The author explains side effects without being alarmist. The section on novel therapies, such as enemas with xylocaine or short-chain fatty acids, adds little, since these remedies are not easily available to patients or their physicians.
Surgical therapy is described and illustrated. A chapter presents the development of surgery for ulcerative colitis from 1930 to the present. Modern surgery is comprehensively explained, although, having never seen a continent ileostomy, I wondered why this procedure was explained in detail.
Complications of IBD and therapy, and the risk of cancer caused by this disease, are handled in a clinical and forthright fashion. Prevention is emphasized. A section on living with the disease covers issues such as life and disability insurance, employment and quality of life. This section emphasizes that most people with IBD perform as reliably and productively as anyone in the job market. This chapter also gives reliable data on sexuality, fertility, pregnancy and childbirth.
Saibil's book is wide ranging and comprehensive enough to educate patients and their families. It can reduce stresses among family members and give patients and their physicians ultimate responsibility for the management of IBD.
Donald S. Daly, MD, FRCPC
McGill University
Senior gastroenterologist
Montreal General Hospital
Montreal, Que.