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Evidence Based Gastroenterology and Hepatology
  1. William Rosenberg, MA, MBBS, DPhil
  1. University of Southampton Southampton, UK

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    This book aims to provide an evidence-based resource for gastroenterologists and hepatologists. The editors have assembled an impressive array of contributors, many of whom are leading authorities in the field. It does not set out to replace traditional textbooks but rather to present up-to-date summaries of the evidence in key areas of clinical practice. The book assumes that clinicians are too busy to access primary or secondary evidence for themselves.

    The chapters are heavily referenced, but no indication is provided of how the evidence was retrieved or selected. An outline of how to critically appraise articles about treatment and diagnosis is provided, adapting the “Users' Guides to the Medical Literature” series of articles published in JAMA. However, no explicit statement indicates that contributing authors were required to use this common set of criteria. Some authors have apparently adhered to some guidelines for critical appraisal, but it is not clear that all authors have used the same guidelines.

    A simplified set of criteria for grading recommendations and levels of quality of evidence has been taken from the textbook Evidence Based Cardiology. 1 Recommendations are only made for evidence concerning treatment, and 3 grades of recommendation are recognised.

    The introductory chapter focuses on one aspect of evidence-based medicine (critical appraisal), and no mention is made of question formulation, searching for evidence, or the integration of evidence into the care of patients. The editors establish a dichotomy between evidence-based medicine (redefined as “the application of the most valid scientific information to the care of patients”) and “traditional skills,” asserting that evidence-based medicine will “never supersede the recognised virtues of careful observation, sound judgment, and compassion for the patient.” These statements suggest that the editors may misunderstand what is meant by “evidence-based medicine,” ignoring that by definition it involves the integration of the best available evidence with clinical expertise and patients' values.

    Evidence Based Gastroenterology and Hepatology covers most of the key topics in the field. The chapters cover the gastrointestinal tract in a traditional order: esophagus to rectum, gallbladder, liver, and pancreas. Each chapter focuses on a clinical problem and attempts to examine epidemiology, clinical presentation, diagnosis, treatment, and prognosis. Recommendations about treatment appear in shaded margin boxes with an “R” logo beside the paragraph containing the evidence. Unfortunately, these paragraphs often contain more than 1 reference, and it is not clear to which reference the recommendation applies. In some chapters, small boxes containing recommendation grades are incorporated at the end of sentences and are much easier to understand.

    McDonald J, Burroughs A, Feagan B, eds. Evidence Based Gastroenterology and Hepatology. London: BMJ Publishing Group; 1999.

    For all of its shortcomings as an evidence-based textbook, this work is clinically useful as a short, problem based textbook of gastroenterology and hepatology. It is well researched, well written, and up to date with plans for electronic updates on a web site, according to the publishers. It remains to be seen how regularly and how well this site will be maintained, which might be the test of the book's shelf life. This book will probably be used by either specialists or generalists who wish to gain a rapid overview of the evidence relating to common problems in gastroenterology and hepatology. Most answers to questions about treatment are easily accessible and can be found within a matter of minutes, especially where the recommendations occur in the text rather than just in the margin boxes. However, the parts of the book that attempt to cover the skills of clinical epidemiology are poor, and most aspects of the practice of evidence-based medicine are neglected. These omissions do not detract from the usefulness of the book; they merely raise questions about the labelling and packaging of the contents. Were this book called A Short Textbook of Gastroenterology and Hepatology, I would have little hesitation in recommending it.

    Ratings for this resource

    Methods/Quality of information: ★★☆☆☆

    Clinical usefulness: ★★☆☆☆


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    • Evidence Based Gastroenterology and Hepatology can be purchased online at for £85; the contents of the book can also be viewed on this site.