Gastrointestinal physiology. Third ed

Gastrointestinal physiology. Third ed

GASTROENTEROLOGY 1986;90:2034-8 BOOK REVIEWS Armand Littman, M.D. Book Review Editor Veterans Administration Hines, Illinois 60141 Hospital Gastr...

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Armand Littman, M.D. Book Review Editor Veterans Administration Hines, Illinois 60141


Gastrointestinal Physiology. Third ed. Edited by L. R. Johnson. 164 pp., 108 figures, $16.95. C. V. Mosby Co., St. Louis, Missouri, 1985. Leonard (Rusty) Johnson and three colleagues from Departments of Physiology (G. E. Castro, D. Jacobson, and N. W. Weisbrodt) have published the third edition of this text which is aimed at medical students, graduate students in the basic medical sciences, as well as physicians. The organization of the book is straightforward. Regulation, which is interpreted as involving peptides and neuromuscular events, comprises the first two chapters; motility involves four chapters; secretion (salivary, gastric, pancreatic, and biliary) comprises four chapters; and the purpose of the gut [digestion and absorption) is allocated only 85 of the 155 pages of the book. A final chapter is on gastrointestinal circulation. As stated in my review of the first edition, this book deals just with human gastrointestinal physiology. Aspects of gastrointestinal physiology peculiar to the ruminant, for example, are not mentioned. The tone of the book is didactic and the history of the development of key ideas receives only occasional mention. The treatment is qualitative, and there is not a single equation to be found. The book is a lucid, well-written overview of many aspects of human gastrointestinal physiology as we know them today. However, GI physiology is a vast topic, and many subjects are not mentioned: for example, the ecology of the gut, gut immunology, the organization of the villus, the concept and application of nonabsorbable markers, details of the microcirculation of the liver and pancreas, hepatic excretory function, rules for gastrointestinal permeability and for lipid partitioning into the enterocyte, the concept of first-pass clearance, and use of breath hydrogen to measure intestinal transit. There is no mention of newer concepts or advances, such as vesicles in biliary lipid secretion or cholecystokinin radioimmunoassays. Paracellular absorption is not mentioned, and there is no discussion of vomiting or fecal composition. The illustrations are clear but scanty. It would have been helpful to show a villus, as well as the location of the endocrine and paracrine cells along the gastrointestinal tract. The introductory chapter on peptides fails to include a typical dose-response curve or discuss second messengers. There are a few errors. Bile acids are stated to have a branched side chain of five to nine carbons. The concept of bile acid-dependent flow differs from that usually accepted. The unstirred layer is shown as only a little larger than the size of an enterocyte. But, as I wrote regarding the first edition, this is a concise and readable text that will certainly be useful to a

student who “just wants the facts.” In these days of the information glut, the expansion of knowledge has given these authors the impossible task of assembling all of the essential information without losing the romance of discovery and the histories of the personalities who developed the current concepts. There is little doubt that the present volume will be highly useful. One hopes that the book will be used together with or guided by a teacher who will excite and inspire the student to dig still more deeply into the fascinating mysteries of gastrpenterology. These can be found in Johnson’s more comprehensive text (Physiology of the Gastrointestinal Tract), and there are illustrations galore available in the Undergraduate Teaching Project of the American Gastroenterological Association. ALAN F. HOFMANN, M.D.

San Diego, California

Small Intestinal and CoJonic Motility (Proceedings of the First International Symposium). Edited by P. Poitras. 145 pp. Jouveinal Laboratories, Montreal, Canada, 1984. The subject of gastrointestinal motility has expanded so much during the last two decades that it is unthinkable to cover all aspects in a one-day conference much less to write a small book, like the one under review, on this subject. The bias of the editor is evident in the introduction where he says “Since the early seventies, the basic motor organization of the small intestine is considered to be the interdigestive migrating complex. . . .” The primary motor function of the gastrointestinal tract is what it does after a meal. But for that function we need no small intestine. The migrating motor complexes are absent in nonruminants after a meal and hence they cannot represent the basic motor organization of the small intestine. Consequently, the title of the book is misleading. The book covers a few specific topics on small intestinal and colonic motility such as migrating motor complexes, in vitro myogenic control of colonic motor activity, and possible motor and behavioral disorders in irritable bowel syndrome. The first two chapters cover the neural and hormonal control of migrating motor complexes. The hormonal control of motor complexes is not critically reviewed. This chapter and the chapter that follows on enkephalinergic control of gastrointestinal motility (really motor complexes) remind us of the question “What is physiological?” The last two chapters in this section describe alterations in migrating motor complexes in pathophysiologic and postsurgical states. Both chapters are well written and provide a balanced view of an area where much more work needs to be done. Collins’ conclusions that interruption of normal migrating motor complexes can result in clinical