Endoscopy has revolutionized clinical gastroenterology. In 1961 Basil Hirschowitz published the first flexible endoscopic examination of the stomach and duodenal bulb. We moved from flexible fiberendoscopes to current video-endoscopic equip ment. Current video-endoscopes incorporate a black and white or color 'chip' at the tip of the instrument which transforms the visual image into electronic signals. The size of the pincet is constantly getting smaller, heading for 5 /Lm, further increasing the resolution. The signals are reassembled into high-quality color images in a video monitor. Endoscopes are now used to examine the entire gastrointestinal tract from esophagus to rectum, including the biliary and pancreatic ductal system. Targeted endoscopic biopsy offers rapid and precise diagnosis. Endoscopic ultrasonography is of unsurpassed accuracy in staging gastrointestinal tumors, in assessing pancreatic and biliary disease, and disorders of the rectum and anal canal. Moreover, targeted cytological sampling is possible of abnormalities of the intestinal wall or peri intestinal lymph node. Yet despite these glamorous achievements changes are to be expected in the overall emphasis of diagnostic endoscopy. Magnetic resonance cholangiopancreatography may very well compete for a substantial fraction of diagnostic ERCP. Virtual colonoscopy or computed tomographic colography may well compete with (and take over?) screening/surveillance colonoscopy."

R. Fuller 1.1 DEVELOPMENT OF COMMERCIAL PREPARATIONS The history of the probiotic effect has been well documented many times previously (see e.g. Bibel, 1982; Fuller, 1992). The consumption of fermented milks dates from pre-biblical times but the probiotic concept was born at the end of the last century with the work of Metchnikoff at the Pasteur Institute in Paris. In the century that has elapsed since Metchnikoff's work, the probiotic concept has been accepted by scientists and consumers throughout the world. Attempts to refine the practice from the use of traditional soured milks to preparations containing specific micro organisms have occupied the thoughts and endeavours of scientists in many different countries. But, in spite of the large amount of effort expended in attempting to explain and define the effect, it has to be admitted that little is known of the way in which probiotics operate. There are likely to be several different mechanisms because it seems highly improbable that a mode of action that explains resistance to microbial infection will also hold true for improved milk production or alleviation of lactose malabsorption."

The pancreas is about the size and shape of the hand; the tail points to the spleen, and the head is nestled in a loop of the duodenum. Loss of the exocrine (digestive) func tions commonly leads to severe gastrointestinal disturbances, malabsorption, a cata bolic state, and weight loss in the face of an adequate diet. Loss of endocrine pancreatic function leads to a large spectrum of disorders associated with the loss of hormone secretions; the most common and most severe is diabetes mellitus. Loss of the entire pancreas owing to trauma, surgery, atherosclerosis, or other medical problems leaves the patient in a digestive and metabolic crisis. The correct diagnosis of pancreatic disorders remains a challenge given the multi faceted function of the pancreas. The clinical laboratory plays an important role, and other tools such as CAT scans, ultrasound, radiographs, biopsies, and even surgery are used to make a diagnosis. The emphasis of Clinical Pathology of Pancreatic Disorders is on the clinical laboratory definition of pancreatic pathology. Disorders of the endocrine pancreas can be highly complex, and sophisticated tests are needed to determine the nature of the disease, its prognosis, and its optimal treat ment. Diabetes is the most common of the endocrine diseases; it presents in many ways, and has varied etiologies. We now know that the diabetes of childhood is usually an autoimmune disease, and this has a major effect on the treatment of these individuals."

By 1977 it was clear that the thermophilic campylobacters were a major cause of acute bacterial enteritis. In response to that observation an international workshop was convened in Reading, England, and attracted over 130 participants. Many of these individuals resolutely returned for the eighth in the series of biennial international workshops, this time held in Win chester, England, in July 1995. All were surprised at the continued, and even expanding, re search effort in this narrow microbiological field. Such a lasting interest is undoubtedly a reflection of a consistent rise in the incidence of infection, the growing number of closely re lated organisms and disease associations, and an ever-increasing awareness by the public and government agencies of public health and food safety issues. The second workshop in Brussels in 1983 was a forum that demonstrated the growing awareness in the campylobacter community of the existence of campylobacter-like organisms and provided the platform for presentations describing the association of these organisms, now classified in the genus Helicobacter. with gastroduodenal disease. The clinical aspects of the research into helicobacters is now thoroughly covered in several other meetings, and the remit of the international workshop has been expanded to provide a forum for the presentation of the basic microbiological research carried out on these bacteria. In a continuation of this ap proach the remit of the workshop has been further extended to other related organisms, reflect ing that there are many other campylobacter-like organisms still to identify and characterize."

A practical, portable handbook, newly updated with nearly 100 color images and figures, The Little GI Book: An Easily Digestible Guide to Understanding Gastroenterology, Second Edition is an invaluable resource for anyone new to the world of gastroenterology and hepatology. Featuring new information on the latest advancements in gastroenterology and hepatology and written in a friendly, conversational style, The Little GI Book will help readers learn the core concepts of digestive health and disease and absorb important information without a hiccup. Author Dr. Douglas G. Adler provides a comprehensive, soup-to-nuts guide to gastrointestinal anatomy, physiology, disease states, and treatment. With new color images throughout, The Little GI Book guides the reader through the entire gastrointestinal tract, starting at the top with the esophagus, ending at the bottom with the colon and rectum, and covering everything in between: the stomach, small intestine, liver, pancreas, bile ducts, and gallbladder. The Little GI Book is an indispensable pocket guide for residents, students, nurse practitioners, office staff, industry sales force, and anyone who works in the GI industry but isn't a gastroenterologist.

This atlas provides a concise yet comprehensive overview of high-resolution manometry, impedance and pH monitoring. Through instructive text and over 130 high-yield images, the atlas describes the basic principles of esophageal, antroduodenal and anorectal high-resolution manometry, reviews both normal and pathologic findings on manometry, covers technical aspects of pH monitoring and impedance, and outlines advances in equipment, software, and diagnostic guidelines. Written by experts in the field, Atlas of High-Resolution Manometry, Impedance, and pH Monitoring is a valuable resource for gastroenterologists and other clinicians and practitioners who work or are interested in the GI motility field.

The impact of Helicobacter pylori on basic science and the clinical management of patients with the complications of this infection is bewildering. The explosion of new information both in the laboratory and at the bedside has progressed at an unprecedented rate. Our main objective in furthering this progress has been to integrate this new information and organize a series of top quality presentations and discussions between investigators and clinicians on all aspects of H. pylori research and to review the current position and future research directions. To that end, the second meeting Helicobacter pylori: Basic Mechanisms to Clinical Cure was organized in June 1996 in Ottawa, Canada, following the successful format of the first such meeting held in Amelia Island, Florida, in 1993. The meeting again focused on all timely aspects of H. pylori research. Internationally renowned basic and clinical scientists, all experts in their respective fields, explored in depth the spectrum of H. pylori infection and the related complications of gastritis, peptic ulcer, gastric cancer and lymphoma. The presentations covered: the genetic heterogeneity of the organism, including the expression of virulence factors determined by the genetic pathogenicity island; the intricate cascade of chemokines and cytokines leading to mucosal inflammation; the complexities of the mucosal immune response, favoring a slight Th1 over Th2 lymphocyte imbalance; the fundamental issue of the apparent paradox of the induction of both apoptosis and epithelial hyperproliferation; the pathophysiological consequences of gastric mucosal inflammation with respect to the elevation of gastrin and the acid secretory response; themechanisms leading to peptic ulcer disease, gastric carcinoma and gastric mucosa-associated lymphoid tissue (MALT) lymphoma; the established and novel therapeutic approaches to eradication and finally the prospects for successful therapeutic and preventative vaccination. The comprehensive manuscripts in this book of the proceedings of the meeting reflect the most up-to-date information and state of the art approaches to research and management of H. pylori infection and will provide an invaluable reference source.

Biliary tract complications are still the major cause of morbidity following orthotopic liver transplantation. This book deals systematically with the large variety of possible cholangiographic changes. The figures are the results of a review of cholangiograms from more than 280 patients who underwent orthotopic liver transplantation. The etiology, clinical aspects, and treatment of these complications are reviewed on the basis of the authors' experience in radiology, endoscopy, and transplant surgery.

As we approach the end of this millennium, enteric diseases remain impor tant public health problems. In many parts of the world, sanitary measures have advanced little over the last century, although some of the governments in those areas are striving to improve facilities for sanitation and to educate their people in proper handling of food, water, sewage, and other modes of transmission of pathogenic microbes. Even in highly developed countries, outbreaks of diarrheal diseases occur today. Globally, the annual morbidity from enteric infections is estimated at several billion and deaths at several million per year. In this volume, descriptions of some of these diseases, of immunity that results from them, of clinical studies that promote under standing of individual and community immunity, of molecular factors of pathogenesis, and/or of advances in vaccine development have been pro vided by leading researchers. At present, the application of molecular methods is enhancing the identification of protective antigens of many microorganisms. In addition, new methods for design and delivery of vac cines are being devised. Perhaps then more effective tools for reducing at least some of these diseases will be available within the next decade. Lois J. Paradise Herman Friedman Mauro Bendinelli vii Contents Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv LOIS J. PARADISE 1. Indigenous Microorganisms as a Host Defense 1 KENNETH H. WILSON 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Composition of Intestinal Biota. . . . . . . . . . . . . . . . . . . . . . . . 2 3. Molecular Approaches to Determine Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4. Role of the Host in Determining the Composition of the Biota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ."

There is currently an explosive growth of basic and clinical research in inflammatory bowel diseases. The extensive interest of the medical community in these diseases is largely explained by the devastating impact the illnesses have on the quality of life, their high prevalence in the community, and the fact that so many medical disciplines are involved in tackling the immensely complex studies on pathogenesis, clinical expression and treatment possibilities. The Falk Symposium No. 85 held in The Hague, the Netherlands, 29 June-1 July 1995 brought together over 80 speakers and 1000 participants from all over the world. Plenary sessions and workshops allowed the discussion of basic and clinical research, enabling appropriate choices to be made. Topics reflected areas of high current basic research interest, clinical importance, and actual or future treatment potential. Audience: An important work for all disciplines involved in research and therapy of inflammatory bowel diseases.

Falk Symposium No. 82, held in Halle, Germany, November 1994, focuses on the advances made in understanding the aetiology and pathogenesis of inflammatory bowel disease (IBD). Sections of this book, the Proceedings of the conference, are devoted to extraintestinal manifestations, cancer development, IBD in the context of pregnancy, and the assessment of disease activity, prognosis and quality of life. The second half of the book is devoted to the discussion of standards and new developments in diagnosis, conservative management and surgery. Audience: All clinicians and basic scientists working in the field of IBD.

Despite recent advances, the pathogenesis and therapy of various forms of chronic inflammatory diseases of the gastrointestinal tract remains problematical. Especially threatening is the possible complication of the development of a malignant growth, but the role of the chronic inflammatory process in this is not known. Three examples are: H. pylori-induced gastritis is associated with gastric lymphomas and carcinomas; there is an increased incidence of intestinal T-cell lymphomas in tropical sprue; and chronic inflammatory bowel diseases, particularly ulcerative colitis, are associated with an increased incidence of carcinoma. In this book, the Proceedings of Falk Symposium No. 81, held in Berlin, November 3-5, 1994, an extensive exchange of information and opinions between international experts yields a state-of-the-art consensus on practical procedures in diagnostics, prophylaxis and therapy.

The last volume in the series Fibrin Sealing in Surgical and Nonsurgical Fields discusses various uses of fibrin glue in endoscopic surgery. During the last years fibrin sealant has been established in the treatment of gastrointestinal ulcers and esophageal fistulae.

This volume is a compendium of the lectures, presentations, and workshops of the International Congress entitled "Facing the Pancreatic Dilemma" and of the 17th Meeting of the Italian Association for the Study of the Pancreas, held in Verona on 16 -19 June 1993. Pancreatology is still a relatively young science. Many pathophysiological aspects of pancreatic disease are as yet obscure, and a fair number of the etio pathogenetic mechanisms adduced are no more than hypothetical. We have therefore chosen to compare and contrast in a single volume the various hypo theses and interpretations put forward by leading experts in the field. In view of the swift evolution of this branch of medical science, it is sound policy to bear in mind that yesterday's heresies have become today's orthodoxy, and that todays's heresies may well turn out to be accepted orthodoxy in a not too distant future. The various "pancreatic dilemmas" are addressed systematically in these pages, and we believe that the book will prove an invaluable tool for the special ist and for any physician dealing with pancreatic disease. The book also represents a tribute by the Verona School of Pancreatology to the memory of Prof. L. A. Scuro, founder of the School and one of the outstanding Italian pioneers of pancreatology."

This book contains the proceedings of the XIIIth International Bile Acid Meeting (Falk Symposium 80), an official satellite meeting of the World Congress of Gastroenterology, held in San Diego, California, U.S.A., September 30--October 2, 1994. It begins with presentations of major advances in bile acid chemistry, biology and pharmacology. The new structure proposed for the mixed micelles present in bile is reviewed, as are the properties of new synthetic analogues of bile acids. The mechanisms by which bile acids interact with cell membranes are discussed in order to provide insight into the hepatotoxic effects of bile acids in cholestatic liver disease. The book further shows the exciting progress in the molecular biology of bile acid transport by the hepatocyte and enterocyte, and concludes with a consensus on the use of ursodeoxycholic acid in cholestatic liver disease and as an adjunct to immunosuppressive therapy after liver transplantation, and to interferon therapy in chronic viral hepatitis.

Practising evidence-based medicine necessarily depends on the clinician having access to the best evidence available, but in a fast-moving field, keeping up to date with the latest developments is a challenging prospect. In this new volume, leading experts focus on the most important clinical issues associated with the management of Lipid Disorders, evaluating and interpreting the evidence available to provide the reader with a reliable summary of our current knowledge. Topics covered include therapeutic strategies for managing hereditary lipid disorders, including familial hypercholesterolaemia, both in adults and children, and familial combined hypercholesterolaemia. The authors also evaluate the evidence for a link between inflammatory disease and cardiovascular risk; the metabolic syndrome and the interconnections between dyslipidaemias and diabetes. They also look at therapeutic challenges such as the management of patients who are statin resistant, and the control of lipid levels in those suffering renal insufficiency. Tables highlight important data, evidence from trial results and expert reports, and each section concludes with a series of Key Points that present a summary of evidence-based recommendations for best practice, graded according to the quality of that evidence. The book provides the busy clinician with a unique analysis of the data supporting current therapies and will help the reader formulate effective strategies for treating their own patients.

Chronic inflammatory bowel disease still represents a major gastroenterological challenge, in view of the unclear aetiology and unsatisfactory therapy. This book, the proceedings of a Falk Symposium held in L beck, Germany on 4--5 March 1994, will act as a vehicle for our current knowledge, and promote the dialogue between clinicians and those involved with the associated sciences. The book begins with international experts discussing the more recent theories concerning the aetiology and pathogenesis. Later on, the discussion turns to questions of diagnosis, and the conservative and surgical treatment of Crohn's disease and ulcerative colitis are dealt with in detail. This volume in the Falk Symposium both represents a forum of experts for discussion of the most recent findings, and provides clinical gastroenterologists with an opportunity to inform themselves of the state of the art in the field of inflammatory bowel disease.

International researchers summarize the current understanding of peptic disease and trace the development of a novel new drug for peptic disease therapy-sucralfate. Contributors present laboratory research along side data from clinical trials as well as from the practice of medicine. Articles discuss the history of sucralfate's development, mechanisms of action, clinical efficacy, and future directions for research. This volume will be of interest to scientists and clinicians working in gastroenterology and gastrointestinal physiology.

The "Europe against Cancer" programme has, from its inception, emphasised the key role which general practitioners must play in the actions necessary to achieve its aim of reducing the incidence and the mortality from cancer in the European Community. General practitioners, because of their day-to-day direct and continuing contact with patients, playa role not only in primary prevention and education of patients, but also in motivating their patients to accept secondary prevention and screening, some of it carried out by general practitioners themselves. These preventive activities are in addi tion to their traditional role in the care and management of patients with cancer at home, and increasingly, their role in active treatment. In view of the importance of the general practitioner in the "Europe against Cancer" programme, the European Commission, with a view to providing general practitioners with up-to-date useful information, has sponsored the production of this series of publi cations on organbased cancers, especially written for general practitioners. Regis Malbois Advisor in charge of the "Europe against Cancer" programme Commission of the European Communities Brussels Preface Colorectal cancer is the second most common cause of death from malignant disease with a high incidence in many European countries. This book is part of a series of pub lications on major cancer diseases designed for the European family doctor. It is pub lished by the Commission of the European Communities within the context of the Eu rope Against Cancer Programme.

On the subject of stomach and gastric diseases, current cli- nical, morphological, pharmacological, biochemical as well as cellular and molecularbiological aspects will be presen- ted. The articles of the first part of this book will discuss the normal functions of the stomach (such as motility, secre- tion, tissue regeneration etc.). The second part deals with pathophysiological aspects (such as inflammation, ulceration and tumor formation) and modern possibilities of treatment. The authors aim at gaining a deeper knowledge of the sto- mach, its physiology and pathophysiology in order to use this knowledge for the better of their patients.

An experienced pathologist, radiologist and clinician combine forces to review the recent literature on coloproctology and give a precis of the results. Their Highlights in Coloproctology are the ideal source for a clinician or researcher who wants a quick overview of the subject. The book highlights the papers that have had an impact on developments in the field and brings the reader up to date with modern references.

Short chain fatty acids (SFCA) are synthesized by the colonic microflora primarily from non-absorbed carbohydrate; there is also some limited production from non-absorbed protein. In contrast, SFCA are not normally present in the diet. During the past 15 years SFCA have attracted considerable interest in human nutrition, physiology and pathophysiology as a result of the realization that SFCA represent an important mechanism for carbohydrate and calorie conservation and may play a role in various types of colitides and possibly in colonic neoplasia. In addition, SFCA, produced in large amounts by ruminants and other herbivores, have long been the province of veterinary physiologists. This book is based upon the presentations at the 73rd Falk Symposium held in Strasbourg, France, September 8--10, 1993, which brought together researchers and clinicians from five continents. It provides an excellent statement of the present state-of-the-art knowledge of SFCA.

The anastomotic technique plays a predominant role in gastrointestinal surgery. A feared complication is leakage due to the sutures. Such leakage cannot be detected early; consequently, infection spreads locally and systemically. An anastomotic method is generally evaluated according to its rate of leakage, related to the localization, bur real scientific comparisons, i.e., controlled studies, are almost totally lack ing. The criteria of evaluation include the type of suture, the localization, the auxiliary technical tools, practicability, the different forms of wound healing, angiogenesis, and vascularization, among others. The postoperative criteria are complications shortly after surgery, such as bleeding, ruptures, and stenoses of the anastomosis. A standard comparison is made difficult by the variety of cytophysiological and biochemical factors that influence wound healing. In the comparison of larger series one must always take into account differences of auxiliary tools, strategies, and inhomogeneity of patients. A change of one auxiliary tool or of one strategy implies the modification of various target criteria. Often enough, however, one does not sufficiently consider the surgeon's most. important role."

Now that Helicobacter pylori is generally accepted as a key aetiological agent in gastric cancer as well as the main agent in peptic ulcer, it can claim to be the most important new discovery in clinical gastroenterology of the last decade, and yet there is no up-to-date book available on the subject that is designed primarily for the clinical gastroenterologist. This book aims to fill that niche. It should also be of interest to the basic scientist, to those providing a clinical laboratory service (microbiologists and histopathologists), and to epidemiologists and others involved in clinical research.

"Updates in Colo-Proctology" covers the proceedings of the Anglo-Swiss Colo-Proctology Meeting held in St Moritz in 1990. The book contains the papers which were presented and dis cussed there by physicians of the various specialties concerned with the care of patients with diseases of the colon, rectum and anus. The authors, each distinguished in a particular field, have contributed across a wide range of subjects and different dis ciplines. The topics covered include surgical and investigative techniques, cancer, inflammatory bowel disease and specific infections. Being familiar with the previous literature, it is clear that little was really new among the themes presented in St Moritz, but few will deny that many of the techniques and methods of treatment described in this book are truly modern. Some contribute an entirely new dimension to the approach to well known colo-proctological conditions, while others may open up new paths for future research. In addition, in colo-proctology as in other disciplines, advances in treatment almost always bring new problems in the complications which attend them. These are the subject of some of the papers. Although it would be invidious to pick out individual contributions when there is so much that is new to talk about and so much that is old to be looked at in a new light, we should like to record how much we have enjoyed reading and collating these chapters. We hope that others will share our enthusiasm and pleasure.