The History of IBD [Inflammatory Bowel Disease]

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The History of IBD Crohn's

Disease first became known as a medical entity when it was described by

Crohn, Ginsberg and Oppenheimer in 1932.However, reports of

manifestations of Crohn's Disease have been reported as early as 850AD

when King Alfred, "England's Darling", suffered from an illness which

caused pain on eating, discomfort, and much embarrassment. This

affliction plagued the King from the age of 20, without remission. At

the time the illness was thought to be due to witchcraft, or a

punishment for the King's infidelities. In retrospect, however, the

illness was probably Crohn's Disease. Crohn and his partners were not the first to recognize the condition; In

1612 a Doctor performed an autopsy on a young boy, who had complained

of abdominal pain, and noted ulcerations in the intestine, similar to

those found in IBD. Similar reports by others during the 19th century

identified the intestinal pathology of what we know today as IBD. An

article was published in the British Medical Journal of 1913 by T.

Kennedy Dalziel, who reported treating 13 patients who had suffered

from intestinal obstruction. On autopsy he found that all 13 patients

had inflamed gut, especially in the jejunal, ileal and colonic areas.

On examining the inflamed bowel more closely, the transmural

inflammation that is characteristic of the disease was clearly seen. Between

the 1920s and the 1930s increasingly more patients, particularly young

adults, were being seen for symptoms that resembled appendicitis -

abdominal cramps, fevers, diarrhoea, and weight loss. Then,

in 1923, Drs.Berg, Oppenheimer, and Ginzberg, surgeons at the Mt Sinai

Hospital in New York, collected 12 patients with similar symptoms, and

showed that these symptoms were not the result of any other known

disease or organism. Burril

Crohn, in 1930, showed similar findings in two patients that he was

treating. On the suggestion of Klemperer, the two groups of

doctors combined their information, and published their findings in the

1932 JAMA. At the time the disease was called "terminal ileitis", in

view of the predilection of the disease for the end portion of the

small bowel. However, the term "terminal" has rather unfortunate

implications, and the disease is not solely confined to the small

bowel. The term "Crohn's Disease" is now generally accepted. The

JAMA article was published at a time when the medical community were

receptive to the new findings, and the paper was presented to a large

medical audience. As a result Crohn's et al findings were given a large

amount of recognition and publicity, while Dalziel article in the

British medical Journal of 1913 was not. Therefore,

as in many medical findings, Crohn's Disease is only termed Crohn's

Disease due to serendipity - Crohn's was named as the first author of

the article published in JAMA, and the article was published at the

"correct time" and was given a great deal of publicity. Ulcerative

Colitis was first described by Wilks and Moxon in 1875. Before this

discovery, all diarrhoeal diseases were believed to be caused by

infectious agents and bacteria. Wilks and Moxon, were therefore the

first to identify the disease as being from a non-infectious cause.

However, as with Crohn's Disease, the reports of the disease, or

symptoms which we now know are due to ulcerative colitis, had been

reported many years before. An obstetrician, with an interest in

digestive diseases, known by the unfortunate name of Soranus, described

diarrhoeal disease in 130AD. This

disease was once again reported by Aretaeus of Cappadocia in

300AD."Bloody Flux" was a term given to a dairrhoeal disease in the

late 1600's by Sydenham, and this description aptly describes

Ulcerative Colitis. Even

though Sir Wilks described the first case of Ulcerative Colitis,

and hence the discovery has been linked to his name, the true article

that was written was in fact a letter to The Medical Times and Gazette in

1859. The letter contained a description of a post-mortem that Sir

Wilks had performed on a young girl, Isabella, who had died after a 3

week illness. In the letter, it was stated that even though the women

had suffered from dysentery from a non-infectious cause, she had died

as a result of taking a poison that was supposed to induce abortion.

The lady in question was the mistress of Dr. Smethurst, who was

then accused of murdering her.At the doctor's trial there was great

controversy over the cause of death. Some said that Isabella had died

from dysentery, while others claimed that she had died due to

poisoning. At the end of the trial the Doctor was found guilty of

murder.The case was highly controversial and many wrote letters of

support for Dr. Smethurst to the local newpaper. As a result of these

letters, and the conflict over the cause of death, Dr. Smethurst was

granted a pardon by the Home Secretary. If the pardon had never been

granted, the doctor would have been put to death, because his mistress

had died from Inflammatory Bowel Disease! When

Crohn's first described Crohn's disease. it was thought that the two

diseases were distinct from each other. However, more recently it has

become apparent that the two disease may "overlap each other" and the

term "indeterminate colitis" is fequently used. For More Info http://www.mssm.edu/msjournal/67/page263-268.pdf (Dr B Crohn 1932 Paper in Jama. ~~~~~~~~~~~~~~~~~~~~ Facts and Figures UC and Crohn's are chronic (ongoing) conditions, which are not infectious. The most common age for diagnosis is between 15 and 35 (although diagnosis can occur at any age). In

both UC and Crohn's there is a higher chance of developing either

illness if you have a close relative who has the condition. In 10-15% of cases, UC and Crohn's may be difficult to distinguish. Men and women suffer equally. Ulcerative Colitis (UC) Ulcerative Colitis affects approx 95,000 people in the UK – that's about 1 in 600. Approximately 5,500 new cases are diagnosed each year. Crohn's Disease Crohn's Disease affects approx 55,000 people in the UK – that's about 1 in 1,000. Approximately 3,000 new cases are diagnosed each year. Research

shows that the number of people with Crohn's Disease has been rising

steadily, particularly among young people. More recently, numbers have

stabilised. UpdatedApril 2005