Print and Media Review

This is a pocket-sized manual reviewing the pathophysiology, diagnosis, and treatment of Helicobacter pylori infection in the upper gastrointestinal tract. In view of the rapid growth in information on H. pylori infection, the authors aim to provide the reader with an up-to-date review of current knowledge about this organism. In the first chapter, there is a concise review of the pathophysiology of H. pylori infection in the gastrointestinal system. Initially, the epidemiology of H. pylori infection is described, and the link with socioeconomic standing is noted. It is postulated that infection probably occurs through direct contact, although this remains to be proven. The different patterns of gastritis that may occur with H. pylori are described, and how gastritis may predispose to either duodenal or gastric ulceration is expanded. In addition, the importance of virulence factors such as vacuolating cytotoxin, cytotoxin-associated gene, and urease activity are mentioned. How host responses aid in the development of disease is described in detail, with figures that elucidate the necessary points. This detail could leave the reader muddled; however, the authors explain these concepts clearly. The myriad of tests available to diagnose H. pylori infection are divided into hospital and primary care investigations. There is a brief description of each test, including its sensitivity and specificity. There are some minor errors in the text, for example, the implication that H&E stains have the same sensitivity and specificity as the Warthin–Starry and Giemsa stains. The histological micrographs are of excellent quality, as is the figure explaining how the urea breath test works. The treatment section compares the advantages of various antibiotic combinations, specifically double, triple, and quadruple therapy, and covers the various drawbacks, including antibiotic resistance, compliance, and side effect profiles. In view of the large number of regimens, this is an excellent, concise summary and imparts information without confusing the reader. The tables are easy to read and provide a rapid source to return to when a clinical scenario arises in the office. The last section covers the indications for eradicating H. pylori, including follow-up investigations and retreatment regimens for those who do not respond to treatment. The recommendations for therapy of clear-cut indications such as peptic ulcer disease are clearly written with good algorithms provided on how to manage patients with either duodenal or gastric ulcer. The thorny issue of whether to treat patients with nonulcer dyspepsia, gastroesophageal reflux disease, or those at risk of gastric cancer is also addressed. Overall, this is a well-written manual on the current investigation and therapy of H. pylori–associated gastrointestinal diseases. The algorithms and tables add to the text and allow quick reference for a busy practitioner. Some tables are superfluous and could easily have been combined with no loss of clarity, for example, Figures 1.10 and 1.11, 1.12 and 1.14, and 1.13 and 1.15. The photomicrographs would have benefited from arrows showing the bacteria (Figures 1.7 and 2.1) and metaplasia (Figure 1.8). Naming the histological stains used on the figure legends would help the reader to recognize the different stains used in identifying this organism. The references are limited and a large number of abstracts are included. These are relatively minor faults and do not detract from the value of the pamphlet. This is a convenient reference for primary care physicians and house staff. For many gastroenterologists, this pamphlet may be somewhat superficial and basic, but for a compact, easy to carry book, it manages to address the main clinical associations of H. pylori and outlines the appropriate management. The summary on therapy is particularly well written and is easy to follow for the busy clinician. Its target audience seems to be primary care physicians, trainees, and medical students, and for these groups, I would recommend this as a quick primer on this topic. Bottom Line: Drs. Misiewicz and Harris have done an admirable job of summarizing in a concise and readable format the role of H. pylori in gastrointestinal disease. The target audience of this primer are primary care physicians, trainees, and medical students.