Gut feeling

Gastrointestinal, hepatobiliary, and nutritional physiology. E B Chang, M D Sitrin, D D Black. Philadelphia: Lippincott-Raven, 1996 (ix + 302 pp.). ISBN 0-781-70262-3.

Concise and readable, this book relates physiology to underlying basic cellular and molecular processes. That this integrated approach is successful is largely due to Eugene Chang's excellent introductory overview of biochemical and cellular regulatory mechanisms and to the many excellent diagrams -- throughout the book -- showing the role of these processes in organ physiology. Chang's chapters on gastrointestinal motility, gastric physiology, exocrine pancreatic physiology and water and electrolyte transport are lucid and concise overviews. Sitrin's chapters are harder to read but are excellent summaries of digestion and absorption of nutrients. Both contributions will greatly improve my lectures to next year's candidates for the Part I Fellowship examination of the Royal Australasian College of Physicians. The book does have weaknesses. The description of the fate of fat-soluble vitamins is too detailed, and the clinical cases the authors have chosen as examples (which they apparently found useful in their lectures to medical students) do not seem to add much for other readers. But the most important deficiency is in the discussion of hepatic physiology; this is not well written and I doubt that it would help someone new to the subject to gain much insight. The clarity and perspective of the first two sections is largely absent; too much space is dedicated to clinical tests and interpretation of their results and not enough to the underlying physiology they evaluate; and there are too many long lists (e.g., of proteins synthesised by the liver, causes of portal hypertension, and liver function tests). These caveats aside, this is an excellent summary of digestive physiology in only 302 pages. It would be suitable for gastroenterologists wanting to keep abreast of advances in basic sciences, gastroenterology trainees (particularly those commencing research), science graduates embarking on a higher degree, and medical students. Brendan J Crotty Senior Lecturer, Department of Medicine Austin and Repatriation Medical Centre, Melbourne, VIC