Modern Concepts in Gastroenterology PDF
Preview Modern Concepts in Gastroenterology
Modern Concepts in Gastroen terology Volume 1 TOPICS IN GASTROENTEROLOGY Series Editor: Howard M. Spiro, M.D. Yale University School of Medicine COLON Structure and Function Edited by Luis Bustos-Fernandez, M.D. KEY FACTS IN GASTROENTEROLOGY Jonathan Halevy, M.D. MEDICAL ASPECTS OF DIETARY FIBER Edited by Gene A. Spiller, Ph.D., and Ruth McPherson Kay, Ph.D. MODERN CONCEPTS IN GASTROENTEROLOGY Edited by Alan B. R. Thomson, M.D., L. R. DaCosta, M.D., and William C. Watson, M.D. NUTRITION AND DIET THERAPY IN GASTROINTESTINAL DISEASE Martin H. Floch, M.D. PANCREATITIS Peter A. Banks, M.D. A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Modern Concepts in Gastroenterology Volume 1 Edited by Alan B. R. Thomson, M. D. The University of Alberta Edmonton, Alberta, Canada L. R. DaCosta, M. D. Queen's University Kingston, Ontario, Canada and William C. Watson, M. D. Victoria Hospital London, Ontario, Canada PLENUM MEDICAL BOOK COMPANY NEW YORK AND LONDON ISBN-13: 978-1-4612-9002-5 e-ISBN-13: 978-1-4613-1789-0 DOl: 10.1007/978-1-4613-1789-0 © 1986 Plenum Publishing Corporation Softcover reprint of the hardcover lst edition 1986 233 Spring Street, New York, N.Y. 10013 Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher Dedicated to our wives, Jeannette, Judy, and Elspeth Contributors Lawrence J. Brandt, Montefiore Hospital and Medical Center, Bronx, New York 10467 C. J. de Gara, The Intestinal Diseases Research Unit and Division of Gastroenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5 Geoffrey C. Farrell, The University of Sydney and Gastroenterology Unit, Westmead Hospital, Westmead, NSW, Australia 2145 Daphna Fen yves, Clinical Research Centre, Saint-Luc Hospital, Mon treal, Quebec, Canada H2X 3J4 Josef E. Fischer, Department of Surgery, University of Cincinnati Med ical Center, Cincinnati, Ohio 45267 Hugh James Freeman, The University of British Columbia, Health Sci ences Centre Hospital, Vancouver, British Columbia, Canada V6T lW5 David Fromm, Department of Surgery, State University of New York Upstate Medical Center, Syracuse, New York 13210 Grant Gall, Department of Medicine, University of Calgary, Calgary, Alberta, Canada T2N 1N 4 Donald J. Glotzer, Departments of Surgery, Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts 02115 J. Richard Hamilton, Division of Gastroenterology, Department ofPedi atrics, University of Toronto and The Research Institute, The Hos pital for Sick Children, Toronto, Ontario, Canada M5G lX8 vii viii CONTRIBUTORS Walter J. Hogan, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin 53226 R. H. Hunt, The Intestinal Diseases Research Unit and Division of Gas troenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5 D. B. Jones, The Intestinal Diseases Research Unit and Division of Gas troenterology, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5 Jutta K. Preiksaitis, University of Alberta, University Hospital, Edmon ton, Alberta, Canada T6G 2C7 Roy M. Preshaw, Department of Surgery and Gastrointestinal Research Unit, University of Calgary Medical School, Calgary, Alberta, Can ada T2N 4Nl Robert H. Riddell, McMaster University Medical Centre, Hamilton, Ontario, Canada L8N 3Z5 Fergus Shanahan, Division of Gastroenterology, University of Califor nia at Los Angeles School of Medicine, Los Angeles, California 90024 Howard M. Spiro, Section of Gastroenterology, Yale University School of Medicine, New Haven, Connecticut 06510 Giles W. Stevenson, McMaster University, Hamilton, Ontario, Canada L8N 3Z5 Stephan R. Targan, Division of Gastroenterology, University of Califo r nia at Los Angeles School of Medicine, Los Angeles, California 90024 Bryce R. Taylor, Toronto General Hospital, Toronto, Ontario, Canada M5KG lL7 Hillar Vellend, Departments of Medicine and Microbiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada M5G 2C4 Jean-Pierre Villeneuve, Clinical Research Centre, Saint-Luc Hospital, Montreal, Quebec, Canada H2X 3J4 W. C. Watson, Department of Gastroenterology, Victoria Hospital, London, Ontario, Canada N6A 4G5 Foreword A fine team of state-of-the-art researcher/clinicians who know their fields, have contributed to the advancement of knowledge, and are in a position to judge what is truly important have here pooled their thoughts in a series of chapters on the cutting edges of gastroenterology. Four attributes render this volume superior to other update-oriented publications. The first striking feature, which is immediately evident upon scanning the table of contents, is the imaginative choice of subjects, ranging from trav eler's diarrhea and sexually transmitted GI infections through TPN and interventional endoscopy to geriatrics and iatrogenic disease. A second outstanding feature of this volume is its success in balanc ing basic pathophysiology with practical considerations of clinical man agement. This is achieved in the discussions of such diverse topics as acid-peptic diseases, infectious and other diarrheal syndromes, and hep atitis immunization. Throughout the book we are led smoothly from basic science principles to specific recommendations for diagnosis and therapy. This practical emphasis appears repeatedly and sometimes pro duces a delightful surprise, such as a chapter on radiology that is not tech nology-based but instead problem-oriented. A third remarkable feature is the critically analytical perspective adopted by many of the authors. Not content merely to tabulate and review, survey and summarize, they have taken a hard evaluative look at their subjects. Ulcer medications, gallstone dissolution, invasive thera peutic endoscopy, nutritional support systems, pills and prophylaxis for traveler's diarrhea, new operations for inflammatory bowel disease, and other items in the gastroenterological armamentarium are assessed from ix x FOREWORD personal viewpoints that are nourished by extensive experience and crit ical judament. The resuhs are stimulating and refreshina. as exemplified by the welcome infusion of science, commOfl sense, and intellectual curi osity into the controversial arena of food allergy and intolerance. Finally, and most notably, the entire volume is woven together with a rare sensitivity to ethics, ecoBomic and psychosocial concerns, and humanism. These issues are perhaps expected to be raised in considera tioRs of functional bowel disease, reviews of GI disorders in the elderly, or special chapters like Howard Spiro's eloquent contribution on "Dilem mas and Decisions in Digestive Disease." It is particularly gratifying, however, to find humanistic attitudes also permeating discussion of inter ventional endoscopy, TPN, and surgical techniques. This attention to ethical issues is well exemplified by the inclusion of a chapter on "Iatro genic Aspects of Gastroenterological Practice," in which W. C. Watson sensibly warns us, "Just because something can be done does not mean it needs to be done or should be done." David B. Sachar, M.D. Professor of Clinical Medicine Director, Division ofG astroenterology The Mount Sinai Medical Center New York, New York Preface This work arises from submissions made at the first and second symposia on Recent Advances in Gastroenterology held by the Canadian Associa tion of Gastroenterology. The proposed audience for this volume is the general internist and the general surgeon, as well as those in specialties in gastroenterology and hepatology. In addition, this publication will be of use and benefit to senior medical residents preparing for subspecialty examinations in internal medicine, general surgery, and gastroenterology. The rate of change of medical practice and the growth of its scientific and information base are intimidating. This is particularly true of gastro enterology, which has major specialty divisions of its own. Through the generous support of Glaxo Canada Ltd., and with the organizational assistance of the Royal College of Physicians and Surgeons of Canada, the Canadian Association of Gastroenterology is pleased to undertake its commitment to the advancement of science and the improvement in the quality of the care of patients with diseases of the gastrointestinal tract. We are fortunate in having a distinguished group of contributors from North America. Their subjects are diverse, important, and topical. It gives us special pleasure to acknowledge the considerable assis tance from Glaxo Canada, and the support of its former president, the late Mr. Frank Burke. We would also like to express our appreciation to Mr. Frank M. Sabatino of Glaxo Canada for his enthusiastic support of this project. Alan Thomson L. R. Da Costa William C. Watson Alberta and London xi
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