Therapy of Digestive Disorders

1011 Pages·2006·15.9 MB·English

by  MD, M. Michael Wolfe, Gary L. Davis, Francis A. Farraye, MD MSc, Ralph A. Giannella, Juan-R. Malagelada, and Michael L. Steer, MD (Eds.)

D e d i c a t i o n
This book is dedicated to all my colleagues and students for providing friendship and purpose, and to my entire family, and
especially my children, Jessica, Matthew, and Aliza, for their inspiration, love, understanding, encouragement, unremitting
sacrifice, and support, as well as the challenges they continuously provide.
Commissioning Editor : Karen Bowler
Project Development Manager: Shuet-Kei Cheung
Editorial Assistant: Katie McCormack
Project Manager: Rory MacDonald
Cover Designer: Jayne Jones
Text Designer: Stewart Larking
Illustration Manager: Mick Ruddy
Illustrator : Antbits & Tim Loughhead
Marketing Manager (UK/USA): Amy Hey & Laura Meiskey
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© 2006, Elsevier Inc. All rights reserved
First edition 2000
Second edition 2006
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Contributors
Aijaz Ahmed MD Lawrence J. Brandt MD Jonathan F. Critchlow MD FACS
Gastroenterology Fellow Chief of Gastroenterology Department of Anesthesia & Critical Care
Hepatology GI Division Beth Israel Deaconess Medical Centre
Stanford University Medical Center Montefiore Medical Center Boston, MA, USA
Palo Alto, CA, USA Bronx, NY, USA
Srinivasan Dasarathy MD
Vicente Arroyo Perez MD Markus W. Büchler MD Assistant Professor of Medicine
Professor of Medicine, Director Institute for Professor of Surgery Case Western Reserve University
Digestive Diseases Department of Surgery Metro Health Medical Center
Hospital Clinic i Provincial de Barcelona University of Heidelberg Cleveland, OH, USA
Universitat de Barcelona Heidelberg, Germany
Barcelona, Spain Bradley R. Davis MD
Theresa A Byrne PhD Associate Professor of Surgery
Bruce R. Bacon MD Director of Research and Clinical Studies Division of Colon and Rectal Surgery
James F. King MD Endowed Chair in Nutritional Restart Center University of Cincinnati
Gastroenterology Hopkington, MA, USA Cincinnati, OH, USA
Director, Division of Gastroenterology and
Hepatology James H. Caldwell MD Gary L. Davis MD
Saint Louis University School of Medicine Professor, Internal Medicine (Digestive Diseases) Director
St. Louis, MO, USA Division of Digestive Disease Division of Hepatology
The Ohio State University Hospital Baylor University Medical Center
William F. Balistreri MD Columbus, OH, USA Dallas,TX, USA
Director, Division of Gastroenterology,
Hepatology & Nutrition Michael Camilleri MD MRCP FACP FRCP John Del Valle MD
Dorothy M.M. Kersten Professor of Pediatrics FACG Professor of Medicine
Cincinnati Children’s Hospital Medical Center Atherton and Winifred W. Bean Professor, Department of Internal Medicine
Cincinatti, OH, USA Professor of Medicine University of Michigan
Mayo Clinic College of Medicine Ann Arbor, MI, USA
Carl L. Berg MD Rochester, MN, USA
Director of Hepatology Carlo Di Lorenzo MD
Medical Director, Liver Transplantation Andrés Cárdenas MD MMSc Chief, Division of Pediatric Gastroenterology
Associate Professor of Medicine Instructor in Medicine Division of Pediatric Gastroenterology
Digestive Health Center of Excellence Harvard Medical School Columbus Children’s Hospital
University of Virginia Health System Beth Israel Deaconess Medical Center Columbus, OH, USA
Charlottesville,VA, USA Boston, MA, USA
Ram Dickman MD
Adil E. Bharucha MD MBBS Shivakumar Chitturi MD MRCP(UK) Research Fellow
Associate Professor of Medicine Consultant Hepatologist GI Section
Consultant Division of Gastroenterology & Department of Gastroenterology Southern Arizona VA Health Care System
Hepatology Apollo Hospitals Tucson, AZ, USA
Mayo Clinic Rochester Chennai, India
Rochester, MN, USA Eric J. Dozois MD
Umesh Choudhry MD Assistant Professor
Cheryl Blank DO Professor of Gastroenterology Division of Colon and Rectal Surgery
Fellow Mease Hospitals Mayo Clinic College of Medicine
Division of Pediatric Gastroenterology Clearwater, FL, USA Rochester, MN, USA
Children’s Hospital of Pittsburgh
Pittsburgh, PA, USA M.T. Clandinin PLQ Andrew W. DuPont MD
Professor of Agriculture, Food & Nutritional Assistant Professor
Henry Worth Boyce MD Sciences Division of Gastroenterology
Professor and Director University of Alberta University of Texas Medical Branch
Joy McCann Culverhouse Center for Swallowing Edmonton, AB, Canada Galveston,TX, USA
Disorder
University of South Florida Colege of Medicine Ray E. Clouse MD Hashem B. El-Serag MD MPH
Tampa, FL, USA Professor of Medicine and Psychiatry Chief, Clinical Epidemiology and Outcomes,
Division of Gastroenterology Gastroenterology
Washington University Associate Professor of Medicine
St Louis, MO, USA Baylor College of Medicine
Houston,TX, USA
x
Francis A. Farraye MD MSc Stuart L.Goldberg MD Richard H. Hunt FRCP FRCPC FACG
Associate Professor of Medicine and Clinical Chief, Leukemia Service Professor of Medicine
Director Clinical Associate Professor of Medicine Division of Gastroenterology, Department of
Section of Gastroenterology Hackensack University Medical Center Medicine
Boston University School of Medicine University of Medicine and Dentistry of New Jersey McMaster University Medical Centre
Boston, MA, USA Hackensack, NJ, USA Hamilton, Ontario, Canada
Geoffrey C. Farrell MD FRACP Richard C. Golding MD Brian C. Jacobson MD MD MPH
Department of Gastroenterology & Hepatology Senior Attending Physician Associate Director of Endoscopy
Westmead Hospital Division of Gastroenterology Boston University Medical Center
New South Wales, Australia Hackensack University Medical Center Boston, MA, USA
Hackensack, NJ, USA
Ronnie Fass MD FACP FACG Maureen M. Jonas MD
Associate Professor of Medicine Gregory J. Gores MD Professor and Chairman of Internal Medicine
GI Section Professor of Medicine and Chief Division of Gastroenterology
Southern Arizona VA Health Care System Division of Gastroenterology and Hepatology The Children’s Hospital
Tucson, AZ, USA Mayo Clinic College of Medicine Boston, MA, USA
Rochester, MN, USA
David M. Felig MD Emmet B. Keeffe MD
Attending Physician Annette Grambihler MD Professor of Medicine, Chief of Hepatology,
Division of Gastroenterology Division of Gastroenterology and Hepatology Co-Director,
Hackensack University Medical Center Mayo Clinic College of Medicine Stanford University Medical Center
Hackensack, NJ, USA Rochester, MN, USA Palo Alto, CA, USA
Stephen J. Ferzoco MD Norton J. Greenberger MD Ciarán P. Kelly MD FRCPI FRCG
Assistant Professor of Surgery Clinical Professor of Medicine, Harvard Medical Associate Professor of Medicine
Department of Surgery School Department of Gastroenterology
Brigham and Women’s Hospital Senior Physician, Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center
Boston, MA, USA Division of Gastroenterology Boston, MA, USA
Brigham and Women’s Hospital
Henry S. Fraimow MD Boston, MA, USA Robert S. Klein MD
Associate Professor of Medicine Professor of Medicine, and Epidemiology &
Division of Infectious Diseases David Greenwald MD Population Health
Cooper University Hospital Associate Professor of Medicine Department of Medicine
Camden, NJ, USA Albert Einstein College of Medicine Division of Infectious Diseases
Associate Director, Division of Gastroenterology Montefiore Medical Center
Ronald Fried MD Montefiore Medical Center Bronx, NY, USA
Consultant for Gastroenterology and Hepatology Bronx, NY, USA
Gastroenterology and Hepatology Samuel Klein MD
Merian-Iselin Spital Francisco Guarner MD PhD Professor of Medicine & Nutritional Science
Basel, Switzerland Consultant of Gastroenterology Division of Gastroenterology
Digestive System Research Unit Washington University School of Medicine
Sonia Friedman MD Hospital Universitari Vall d’Hebron St Louis, MO, USA
Instructor of Medicine, Harvard Medical School Barcelona, Spain
Gastroenterology Division Kenneth L. Koch MD
Brigham and Women’s Hospital J. Eileen Hay MBChB FRCP Professor of Medicine, Section Head
Boston, MA, USA Professor of Medicine and Consultant Section on Gastroenterology
Division of Gastroenterology and Hepatology Wake Forest University School of Medicine
Helmut M. Friess MD Mayo Clinic College of Medicine Winston-Salem, NC, USA
Professor of Surgery Rochester, MN, USA
Department of Surgery Patricia L. Kozuch MD
University of Heidelberg Ikuo Hirano MD Instructor of Medicine
Heidelberg, Germany Associate Professor of Medicine Department of Medicine
Gastroenterology Fellowship Training Director The University of Chicago
Daniel Gelrud MD Division of Gastroenterology Division of Biological Sciences
Assistant Professor of Medicine Northwestern University School of Medicine Chicago, IL, USA
Department of Gastroenterology Chicago, IL, USA
Jacobi Medical Center Edward L. Krawitt MD
Bronx, NY, USA Richard Hodin MD Professor of Medicine
Associate Professor of Surgery Department of Medicine
Ralph A. Giannella MD Department of Surgery University of Vermont
Mark Brown Professor of Medicine Massachusetts General Hospital Burlington,VT, USA
Division of Digestive Diseases Boston, MA, USA
University of Cincinnati Colege of Medicine J.Thomas LaMont MD
Cincinnati, OH, USA Christopher S. Huang MD Charlotte F. & Irving W. Rabb Professor of
Instructor Medicine, Ha
Pere Ginés Gibert MD Gastro Medicine Chief, Division of Gastroenterology
Associate Professor of Medicine, Chief of Liver Unit Boston University Medical Center Beth Israel Deaconess Medical Center
Hospital Clinic i Provincial de Barcelona Boston, MA, USA Boston, MA, USA
Universitat de Barcelona
Barcelona, Spain
Contributors
xi
Nicholas F. LaRusso MD Lars Lundell MD PhD David R. Nelson MD
Professor and Chairman of Internal Medicine Professor of Surgery Associate Professor
Division of Gastroenterology and Hepatology Department of Surgery Chief, Section of Hepatobiliary Diseases
Mayo Clinic College of Medicine Sahlgrens Hospital Director, Adult Liver Transplant Program
Rochester, MN, USA Gothenburg, Sweden Dept of Gastroenterology, Hepatology and
Nutrition
James Y.W. Lau MD Juan-R. Malagelada MD University of Florida
Consultant, Division of Upper Professor Digestive Diseases Gainesville, FL, USA
Gastrointestinal Surgery Digestive Diseases Department
Department of Surgery Hospital Universitari Val d’Hebron Enders K.W. Ng MD FRCS
Prince of Wales Hospital Barcelona, Spain Assistant Dean (Clinical), Faculty of Medicine
Hong Kong, China Professor and Chief, Upper Gastrointestinal Surgery
Paul Martin MD Department of Surgery
Konstantinos N. Lazaridis MD Professor of Medicine, Associate Director of the The Chinese University of Hong Kong
Assistant Professor of Medicine Division Shatin
Center for Basic Research in Digestive Diseases Recanati / Miller Transplantation Institute Hong Kong, China
Division of Gastroenterology and Hepatology The Mount Sinai Hospital
Mayo Clinic Colege of Medicine New York, NY, USA David P. Nunes MB
Rochester, MN, USA Director of Hepatology
Jeffrey B. Matthews MD Boston University School of Medicine
Mike A. Leonis MD PhD Christian R Holmes Professor and Chairman Boston, MA, USA
Research Instructor in Pediatrics,William E. Department of Surgery
Cooper Procter Scholar University of Cincinnati Jaime Oviedo MD
Division of Gastroenterology, Hepatology and Cincinnati, OH, USA Assistant Professor of Medicine
Nutrition Gastroenterology
Department of Pediatrics Julia Mayerle MD Boston Medical Center
Cincinatti, OH, USA Lecturer Boston, MA, USA
Department of Gastroenterology, Endocrinology
Markus M. Lerch MD and Nutrition Sareh Parangi MD
Professor of Medicine and Chair Ernst-Moritz-Arndt Universität Greifswald Assistant Professor of Surgery
Department of Gastroenterology, Endocrinology Greifswald, Germany Department of Surgery
and Nutrition Beth Israel-Deaconess Medical Center
Ernst-Moritz-Arndt Universität Greifswald Arthur J. McCullough MD Boston, MA, USA
Greifswald, Germany Director of Gastroenterology
Department of Medicine John H. Pemberton MD
Wai K. Leung MD MetroHealth Medical Center Professor of Surgery
Associate Professor Cleveland, OH, USA Division of Colon and Rectal Surgery
Department of Medicine & Therapeutics Mayo Clinic
The Chinese University of Hong Kong James E. McGuigan MD Rochester, MN, USA
Shatin Professor of Medicine
Hong Kong, China Division of Gastroenterology, Hepatology and David A. Peura MD
Nutrition Associate Chief of Gastroenterology and
David R. Lichtenstein MD University of Florida College of Medicine Hepatology
Associate Professor of Medicine Gainesville, FL, USA Professor of Medicine
Director of Endoscopy University of Virginia
Section of Gastroenterology Peter J. Milla MD Charlottesville,VA, USA
Boston University School of Medicine Reader in Paediatric Gastroenterology
Boston, MA, USA Gastroenterology Unit Gilda Porta MD
Institute of Child Health Professor of Pediatrics
Gary R Lichtenstein MD London, UK University of Sao Paulo
Professor of Medicine, University of Pennsylvania Sao Paulo, Brazil
School Daniel S. Mishkin MD CM
Director, Center for Inflammatory Bowel Diseases Instructor of Medicine Charlene M. Prather MD
Hospital of the University of Pennsylvania Section of Gastroenterology Associate Professor of Medicine
Gastroenterology Division Boston University Medical Center Saint Louis University School of Medicine
Philadelphia, PA, USA Boston, MA, USA Saint Louis, MO, USA
Keith D. Lindor MD Kevin D. Mullen MB FRCPI Sarathchandra I. Reddy MD
Professor of Medicine and Dean Professor of Medicine Instructor of Medicine, Harvard Medical School
Mayo Medical School Case Western Reserve University Gastroenterology Division
Division of Gastroenterology and Hepatology and Consultant of Gastroenterology Brigham and Women’s Hospital
Rochester, MN, USA GI Division Boston, MA, USA
Metro Health Medical Center
Robert M. Lowe MD Cleveland, OH, USA Joachim Richter MD
Educational Director of Gastroenterology Assistant Professor of Medicine; Lecturer,Tropical
Assistant Professor of Medicine and In
Gastroenterology Tropenmedizinische Ambulanz, Klinik für
Boston Medical Center Gastroenterologi
Boston, MA, USA Universitätsklinikum Düsseldorf
Düsseldorf, Germany
Contributors
xii
Malcolm K. Robinson MD Paul C. Schroy III MD MPH Jayant A.Talwalkar MD MPH
Director, Metabolic Support Services Professor of Medicine Assistant Professor of Medicine
Brigham and Women’s Hospital Boston University School of Medicine Mayo Clinic College of Medicine
Assistant Professor of Surgery Section of Gastroenterology Rochester, MN, USA
Harvard Medical School Boston Medical Center
Department of Surgery Boston, MA, USA Beth E.Taylor MS RD CNSD FCCM
Brigham and Women’s Hospital Nutrition Support Specialist
Boston, MA, USA Douglas Simon MD FACG Department of Food and Nutrition
Professor of Clinical Medicine Barnes-Jewish Hospital Plaza
Juan Rodés MD Department of Medicine St Louis, MO, USA
Professor of Medicine Jacobi Medical Center
Hospital Clinic Bronx, NY, USA A. B. R.Thomson MD FRCPC
University of Barcelona Professor or Medicine
Barcelona, Spain Adam Slivka MD PhD Department of Medicine
Associate Professor of Medicine & University of Alberta
Janice G. Rothschild MD, FACS Associate Chief of Gastroenterology, Hepatology Edmonton, AB, Canada
Assistant Professor of Surgery & Nutrition
Department of Surgery UPMC Gastroenterology Tram T. Tran MD
Tufts-New England Medical Center University of Pittsburgh Medical Center Medical Director, Liver Transplant, Cedar Sinai
Boston, MA, USA Pittsburgh, PA, USA Medical
Assistant Professor of Medicine
Richard I. Rothstein MD Consuelo Soldevila-Pico MD Geffen UCLA School of Medicine
Professor of Medicine Associate Professor of Medicine Los Angeles, CA, USA
Assistant Dean Cont. Education Department of Medicine
Chief, Section of Gastroenterology University of Florida Jacques Van Dam MD PhD
Dartmouth-Hitchcock Medical Center Gainesville, FL, USA Professor and Chief of Clinical Gastroenterology
Lebanon, NH, USA Division of Gastroenterology and Hepatology
David I. Soybel MD Stanford University Medical Center
Deborah C. Rubin MD Associate Professor of Surgery Palo Alto, CA, USA
Professor of Medicine Division of General and GI Surgery
Department of Medicine Brigham and Women’s Hospital C. Mel Wilcox MD
Director, DDRCC Morphology Core Facility Boston, MA, USA Division of Gastroenterology and Hepatology
Washington State University School of Medicine University of Alabama
St Louis, MO, USA Stuart Jon Spechler MD Birmingham, AL, USA
Professor of Medicine
Sherif Saadeh MD University of Texas Southwestern Medical Center G. E.Wild MD PLQ
Staff Gastroenterologist & Transplant Hepatologist Chief, Division of Gastroenterology Professor of Medicine
Division of Hepatology Dallas VA Medical Center University of Alberta
Department of Internal Medicine Dallas,TX, USA Edmonton, AB, Canada
Baylor University Medical Center
Dalas,TX, USA Michael L. Steer MD Douglas W. Wilmore MD
Professor of Surgery, Chief of General Surgery Professor of Surgery
Arun J. Sanyal MBBS MD Tufts University School of Medicine Harvard Medical School
Charles Caravati Professor of Medicine Tufts-New England Medical Center Department of Surgery
Chairman, Division of Gastroenterology and Boston, MA, USA Brigham and Women’s Hospital
Hepatology Boston, MA, USA
Medical Colege of Virginia Joseph J.Y. Sung MD PhD FRCP FRCPE
Richmond,VA, USA FRACP FACP FHKAM FHKCP Jacqueline L.Wolf MD
Professor of Medicine Associate Professor of Medicine
Miguel Saps MD Chairman Department of Medicine and Division of Gastroenterology
Division of Pediatric Gastroenterology Therapeutics Beth Israel Deaconess Medical Center
Children’s Memorial Hospital of Chicago Director, Center for Emerging Infectious Diseases Boston, MA, USA
Chicago, IL, USA New Territories
Hong Kong SAR M. Michael Wolfe MD
Lawrence J. Sauberman MD Professor of Medicine and Chief,
Assistant Professor of Medicine Christina M. Surawicz MD Section of Gastroenterology
Gastroenterology Division Professor of Medicine Boston University School of Medicine
Brigham and Women’s Hospital Harborview Medical Center Boston, MA, USA
Boston, MA, USA University of Washington
Seattle,WA, USA Yuhong Yuan MD MSc PhD
Robert E. Schoen MD MPH Research Associate
Professor of Medicine and Epidemiology Jan Tack MD PhD Division of Gastroenterology, Department of
Division of Gastroenterology, Hepatology and Professor of Medicine Medicine
Nutrition Head of Clinic, Department of Gastroenterology McMaster University Medical Centre
Pittsburgh, PA, USA University Hospitals Leuven Hamilton, Ontario, Canada
Leuven, Belgium
Contributors
Preface to the second edition
During the past three decades, gastroenterologists and other edition, several new chapters and sections and new features have
healthcare workers engaged in the management of patients with been included in the second edition of this textbook. They include:
digestive disorders have been witness to remarkable improve-
(1) A chapter devoted in its entirety to the use of probiotics in the
ments in the understanding of the biology of these commonly
management of gastrointestinal disorders;
encountered problems. Moreover, advancements in the elucida-
tion of the pathogenesis of various digestive disorders and the (2) A section on the treatment of the ever-increasing problem of
exponential increase in therapeutic modalities for the treatment nonalcoholic fatty liver disease;
of these diseases have been unsurpassed during this same period
(3) A chapter devoted to the management of gastrointestinal
of time. The universal availability of fiberoptic, and more recently
diseases in the elderly;
video and wireless capsule, endoscopy and the widespread employ-
ment of minimally invasive surgery, have facilitated the ability of (4) A chapter that focuses on the management of gastrointestinal
gastroenterologists and gastrointestinal surgeons to investigate diseases in children;
and provide therapy for the multitude of persons suffering from
(5) A chapter that considers the special and specific issues encoun-
the vast array of digestive disorders. This spectacular progress
tered during the management of pregnant women with acute
has enabled practitioners to extend the technological advances
and chronic digestive and hepatic disorders;
and improvements in pharmacological treatment to the masses,
and in doing so, have diminished morbidity, improved survival, (6) Owing to the significant recent advances in our understand-
and enhanced the quality of life for the hundreds of millions of ing of their pathogenesis, as well as marked improvements in
individuals afflicted with these diseases. the therapy of inflammatory bowel diseases, separate chapters
on the management of Crohn’s disease and ulcerative colitis;
One prominent example of our remarkable progress during this
period of time is the management of gastroesophageal reflux (7) All chapters now include succinct summaries with specific
disease (GERD). Beginning in the mid-1970s with the availability treatment recommendations;
of the histamine H2-receptor antagonists and, more recently, the
(8) Annotated references to help guide readers to the review of
proton pump inhibitors, as well as surgical and endoscopic
specific topics;
approaches to the disorder, the treatment of GERD has been
revolutionized. A myriad of individuals, who previously received (9) A PDA version of each chapter for rapid, bedside use.
generally inadequate therapy, have benefited significantly by
The full spectrum, from preventive measures to the therapy of
these remarkably effective and safe agents. The significance of
complex and advanced disease states, is covered in depth, with
gastrointestinal drug development is further evident by the
the liberal use of tables and treatment algorithms to help guide
bestowing of two Nobel Prizes in Medicine and Physiology for
clinicians. My distinguished colleagues and Section Editors –
biomedical research that led to the development of two promi-
Doctors Gary L. Davis, Francis A. Farraye, Ralph A. Giannella,
nent classes of drugs that affect gastrointestinal function: the
Juan-R. Malagelada, and Michael L. Steer – and all the out-
histamine H2-receptor antagonists and prostaglandins. Further-
standing authors have striven to emphasize, extend, and amplify
more, the past decade has witnessed the development of a myriad
specific treatment topics and have provided contemporary
of new classes of medication, including specific immunomodu-
citations, several of which have been annotated, to further guide
lators and other drugs used for the therapy of inflammatory bowel
the examination of specific topics. In addition to their respective
diseases, antiviral agents for the treatment of viral hepatitides, and
roles as objective authorities, the contributors have interjected
neuromodulators for the management of irritable bowel syndrome
their own personal expert opinion regarding the appropriate
and other motility disorders of the gastrointestinal tract.
selection of management, including the proper dosing and
Along with these important advances comes the requisite administration of specific medication and the judicious employ-
requirement for practitioners to remain informed, a task generally ment of procedure-based diagnostic and therapeutic modalities.
accomplished by the availability of contemporary textbooks and
The target audience for this textbook includes gastroenterologists,
other literature relevant to their interests and needs. Beginning
gastrointestinal surgeons, and all practitioners who care for
with its inception and formulation and during the preparation of
individuals afflicted with digestive disorders. The contributors
the second edition of this textbook, Therapy of Digestive Disorders
have used utmost care and discrimination in presenting their
was formulated to provide practitioners with an authoritative and
materials, and the subject matter has been composed in a concise,
evidence-based, yet practical, approach to the optimal manage-
yet thorough, format. Accordingly, medical students, internal
ment of individuals afflicted with specific digestive disorders. The
medicine, family medicine, and surgery residents, and gastroen-
text of each chapter focuses on diagnosis and treatment, with less
terology fellows will view this text as an invaluable adjunct to
emphasis placed on epidemiology and pathogenesis. Neverthe-
their educational needs, and it should be regarded as germane to
less, all treatment recommendations are based on the biology and
the practices of primary care and emergency room physicians,
pathophysiology of the specific disease entities. In addition to
intensivists, hospitalists, pharmacists, and other health care
providing updates and expanding the topics included in the first
xiv
professionals involved in the management of diseases of the and educators. All are engaged in clinical or basic investigation
alimentary tract and hepatobiliary systems. and are particularly proficient in the application of basic scientific
information to the realm of patient management. The Section
Therapy of Digestive Disorders is clearly the product of the
Editors and I believe that the second edition of Therapy of Digestive
enormous effort of its superb contributors, some of the most
Disorders has been built upon the high standards set forth in the
capable persons in the fields of gastroenterology, hepatology,
initial text, and that the ultimate recipient of its excellence will be
gastrointestinal surgery, and other medical disciplines, defined in
the patients with digestive disorders, whose care will optimized by
advance by their willingness to respond to the compelling need to
the improved proficiency of their physicians.
share their knowledge and produce quality chapters despite their
other endless commitments. These authors were selected
M. Michael Wolfe, M.D.
primarily for their record of excellence as investigators, clinicians,
Preface to the second edition
Preface to first edition
The logarithmic increase in medical and technological advances the content of Drs. Mark Feldman, Bruce F. Scharschmidt, and
used in the management of individuals with digestive disorders Marvin H. Sleisenger’s landmark Sleisenger and Fordtran’s
during the past two decades is unparalleled. The universal Gastrointestinal and Liver Disease, the authors here have striven to
availability of fiberoptic instruments, and later video, endoscopic, emphasize, extend, and amplify specific treatment topics and
and surgical instruments, has facilitated the ability of gastroen- have provided up-to-date references to direct further examination
terologists and gastrointestinal surgeons to investigate and of specific topics. Although the contributors have written their
provide therapy for the multitude of individuals suffering from chapters as objective authorities, they have also interjected their
the vast array of digestive disorders. These spectacular techno- expert opinions regarding the appropriate selection of thera-
logical advances have enabled practitioners to extend the use of peutic options, including the proper dosing and administration of
noninvasive and minimally invasive methods to the masses, specific medications and the judicious employment of diagnostic
thereby producing diminished morbidity, improved survival, and and procedure-based therapeutic modalities.
probably most important, enhanced quality of life. Equally impor-
The target audience for this text includes all practitioners who
tant to these remarkable achievements, however, was the develop-
care for individuals with digestive disorders. The contributors
ment of a myriad of new classes of medication for the treatment
have used utmost care and discrimination in presenting their
of these diseases. Since the mid-1970s, with the introduction of
materials, and the subject matter is thus appropriate not only for
H2 receptor antagonists, we have experienced a virtual explosion
gastroenterologists and gastrointestinal surgeons, but also for
of new drugs that have revolutionized medical therapy for
medical and surgical residents, primary care and emergency
gastrointestinal illnesses. Since 1978, the leading individual drug
department physicians, intensivists, and other health care
used throughout the world has been one used to treat digestive
professionals specializing in the management of diseases of the
disorders. The significance of their importance is further evident
alimentary tract and hepatobiliary organs. The superb group of
by the bestowing of two Nobel Prizes in Medicine and Physiology
contributors assembled for this book were selected primarily for
for biomedical research that led to the development of two
their record of excellence as investigators, clinicians, and
prominent classes of drugs that affect gastrointestinal function:
teachers. All are engaged in clinical or basic investigation and are
H2 antagonists and prostaglandins.
particularly proficient in the application of basic scientifc
Beginning with its inception and formulation and during the information to the realm of patient management. This book is
writing of this companion book, rather than emphasizing specific clearly the product of the enormous effort of these individual
classes of medication, endoscopic intervention, or surgical pro- authors, some of the most capable persons in the fields of
cedures, Therapy of Digestive Disorders was developed to provide gastroenterology, hepatology, and gastrointestinal surgery,
practitioners with an authoritative and evidence-based, yet prac- defined in advance by their willingness to respond to the
tical, approach to the optimal management of individuals with compelling need to share their knowledge and produce quality
specific digestive disorders. The full spectrum, from preventive chapters despite their other endless commitments.
measures to the treatment of complex and advanced disease
states, is covered in depth, with liberal use of tables and treatment M. Michael Wolfe
algorithms to help guide the clinician. Rather than merely reiterate
Acknowledgements
I am most pleased to be afforded the opportunity to acknowledge the preparation of a textbook of this magnitude. I thank Joanne
the many teachers and mentors, all of whom have inspired me Scott, Henrietta Preston, and especially Shuet-Kei Cheung, Project
immeasurably during my training and career as an academic Managers at Elsevier, who approached the formidable task of
gastroenterologist. It is particularly gratifying for me to have been serving as liaison between the chapter authors, Section Editors,
able to include my medical school advisor, Professor James H. and Elsevier with enthusiasm and zeal, and who made my tasks
Caldwell, as a contributor to the second edition of Therapy of tolerable by streamlining all the various protocols and processes
Digestive Disorders. I also acknowledge the invaluable advice and involved with editing the textbook. In addition to the Project
counseling received over the years from the late Professor Walter Managers, this project would not have been possible without the
Rubin, whose recent untimely death was a tragedy to all who support of Sue Hodgson, Publisher at Elsevier, and Karen Bowler,
revered him. Among the others who played an invaluable and Senior Acquisitions Editor. Finally, a special debt of gratitude goes
instrumental role are Professors Donald Kaye, Phillip P. Toskes, to Rolla Couchman, Senior Acquisitions Editor at Elsevier, who
James E. McGuigan, Gabriel M. Makhlouf, James W. Freston, served as a friend and as an earnest and enthusiastic professional
William Silen, Eugene Braunwald, William W. Chin, and Joseph throughout the course of this textbook’s inception, planning,
Loscalzo. I am deeply indebted to the Section Editors — Gary organization, and composition.
Davis, Frank Farraye, Ralph Giannella, Juan Malagelada, and
Finally, I wish to express my personal appreciation to my fellows
Mike Steer — for their diligence and efforts in assembling a
and colleagues within the Section of Gastroenterology and in the
distinguished, talented, and exceptional group of authors. As a
Department of Medicine for their collegiality and friendship. I
result of their outstanding contributions, we have succeeded in
have been blessed to have the opportunity to work with an
compiling a contemporary textbook that combines a scholarly
unparalleled group of dedicated and accomplished physicians
review of every individual topic with practical guidelines for the
and scientists, who have devoted their careers and lives to
management of the wide array of digestive disorders. The
research, education, and patient care and for maintaining an
ultimate beneficiaries of their efforts will be the hundreds of
environment conducive to creativity and scholarship. I offer my
millions of patients with gastrointestinal diseases, who will
extreme gratitude to my research collaborators and to the devoted
receive the most optimal and contemporary care available.
members of my laboratory, Mike Boylan, Lisa Jepeal, Diane Song,
In addition to the Section Editors and authors, the successful Carlton Moore, Min Yao, Wei Zhou, Albert Chang, Jon Simon,
completion of the second edition of Therapy of Digestive Disorders Tom Liu, and Cherrell Wilson. Their diligent and resolute efforts
would not have been possible without the invaluable support of have consistently produced research of the highest quality that
the group of dedicated professionals and assistants. I would like to have culminated in publications in most prestigious scientific
express my sincere appreciation to Carolyn Dumas, my assistant journals. Lastly, I thank my father, my late mother, sister, brother,
in the Section of Gastoenterology at Boston University School of wife, and children for their endless patience, encouragement,
Medicine, and to Erin Medley, who provided technical assistance. support, and understanding throughout not only the preparation
A special debt of gratitude goes to Linda Neville, Administrator of this textbook, but during my education and career.
in the Section of Gastroenterology, who helped maintain the
excellence of the daily operations of the GI Section when my M. Michael Wolfe
attention was diverted by the formidable challenges faced during