Book Review  |   February 2009
Primo Gastro: The Pocket GI/Liver Companion
Author Affiliations
  • Tyler C. Cymet, DO
    American Association of Colleges of Osteopathic, Medicine Chevy Chase, Md♦
    Associate Vice President for Medical Education
Article Information
Book Review   |   February 2009
Primo Gastro: The Pocket GI/Liver Companion
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 109-110. doi:
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 109-110. doi:
With many reference materials now available in electronic forms in addition to traditional printed and bound versions, it is becoming increasingly difficult for physicians to decide whether to purchase a book and, if they do, which format best suits their needs. 
Online versions of books are useful for locating information that may have changed recently or when the hard copy text is not portable. With more information available electronically, the books most physicians want to own and hold are those that allow us to verify medication or dosage information quickly without sifting through a lot of pages. In light of these developments, print versions of books are now published in a variety of formats. 
Cognizant of the changing needs of today's readers, Jason Guardino, DO, MSEd, developed a handbook on gastrointestinal (GI) and liver health. Primo Gastro: The Pocket GI/Liver Companion is written in a format that is easy to use and serves as a quick reference for physicians who need access to concise information while on the job. 
This book is written with a beginner's eye as to what is interesting and with the thoroughness of a more seasoned clinician. Each chapter has the same outline: clinical definition, epidemiology, etiologic processes, pathophysiology, manifestations seen on physical examination, laboratory and diagnostic studies, treatment options, complications, and prognosis. This structure gives the reader a complete picture of each condition. Physicians can even refer to the book when initiating treatment because dosage guidelines for antibiotics and steroids are also included in each chapter. 
The sections of this book are organized logically by anatomic region as one might expect: “Esophagus/Gastric,” “Small Bowel/Colon/Rectum,” “Liver,” and “Pancreas/Biliary.” Interspersed are sections devoted to “GI Bleed” and “Inflammatory Bowel Disease,” and the book finishes with “Endoscopy and Procedures.” The information in these sections is useful primarily for residents and generalist practitioners working in a hospital setting. 
The topics in each section are organized alphabetically and written in 2- to 4-page chapters using brief passages, outlines, keywords, and font formatting so information is readily found. Additional resources such as consensus statements and review articles are unobtrusively placed at the top of each chapter, guiding the reader to more detailed information. 
For more complex topics, Dr Guardino discusses the history of the problem. Chapters covering issues such as histopathology of liver disease and hepatitis include more extensive coverage when the topic does not lend itself to an outline format. 
Dr Guardino also offers tips and advice in several chapters. For example, in the chapter “Diarrheal Infections,” Dr Guardino suggests that antibiotics are most helpful when treating infectious diarrhea if given within 3 days of symptom onset, when the patient's temperature is higher than 102.2°F (39°C), when blood is in the bowel movement, or when the patient is immunosuppressed. 
Clinical conditions for which there have been recent advances (eg, celiac disease, tropical sprue) are thoroughly covered, including information on test sensitivity and specificity for new diagnostic methods. For example, the chapter on hemochromatosis and iron overload describes genetic testing options for patients and also addresses the symptomatic and asymptomatic heterozygotic and homozygote findings that clinicians would expect to find during the diagnostic testing phase. 
The strengths of the book are also its weaknesses. Brevity is appreciated on rare conditions, but less so for those that are more commonly encountered in the clinical setting. For example, only 4 pages are devoted to irritable bowel syndrome—a chapter that would have benefited from case examples or a discussion of current consensus regarding its etiologic process. 
Similarly, the nutrition chapter presents information regarding orders for total parenteral nutrition, but it doesn't thoroughly explain the thinking that goes into designing a long-term plan for parenteral feeding. 
While the book claims to address mainly common matters in gastroenterology, there are also chapters on less common conditions, like Zollinger-Ellison syndrome, and “pearls of wisdom” related to pregnancy and gastroenterology. So, for example, I learned that while maternal blood volume and cardiac output increase in pregnancy, there is not a corresponding increase in liver blood flow. This situation results in a net decrease in blood flow to the liver during pregnancy. 
These “clinical pearls” get the reader thinking—when you are taking care of a patient with pancreatitis, it is useful to be reminded that 85% of patients with pancreatitis will also have diabetes. 
Primo Gastro reads like a polished set of high-quality study notes for gastroenterology. There are even empty pages provided to write your own thoughts or notes on various topics. While this is a book that is best read one topic at a time, there is an extensive appendix that is useful when you have questions that do not fit nicely into a specific area. 
If you are starting residency in the primary care field or need to renew your knowledge in gastroenterology, Primo Gastro is a good book to buy and worthwhile to have in print form. 
 By Jason Guardino, DO, MSEd. 328 pages, $49.95. ISBN: 978-0-7817-7944-9. Philadelphia, Pa: Lippincott Williams & Wilkins; 2008.
 Editor's Note: Corrections to this article were published in the July 2009 issue of JAOA—The Journal of the American Osteopathic Association (2009;109:388). The corrections have been incorporated in this online version of the article, which was posted December 2009. An explanation of these changes is available at: