Crohn's disease is a chronic inflammatory condition of the gastrointestinal (GI) tract that can give rise to strictures, inflammatory masses, fistulas, abscesses, hemorrhage, and cancer. This disease commonly affects the small bowel, colon, rectum, or anus. Less commonly, it can also involve the stomach, esophagus, and mouth. Often, the disease will simultaneously affect multiple areas of the GI tract.
The cause of Crohn's disease is not known and there is no curative treatment. Current medical and surgical treatment is effective at controlling the disease, but even with optimal treatment recurrences and relapses are frequent. The combined approach of optimal medical treatment with timely and strategic surgical intervention offers the most effective management to patients affected by Crohn's disease. Crohn's disease, however, can be particularly challenging, as it has a myriad of manifestations and potential complications. Additionally, its course and response to therapy can be difficult to predict. To add to the overall complexity, there are many therapeutic options that must be tailored to each individual patient and to each site of involvement to achieve optimal outcomes.
Crohn's disease was fully recognized as a specific pathological entity in 1932 when Crohn et al first identified regional enteritis as a unique clinical entity.1 In retrospect, case descriptions of what appeared to be Crohn's disease date back to at least 1612, when Fabry reported on the death of a boy experiencing severe abdominal pain.2 Autopsy revealed a contracted ulcerated cecum and ileum with complete bowel obstruction. In 1761, Morgagni described a case of an inflamed ileum with perforation and thickened mesentery in a young man with a history of diarrhea and fever.3,4
It is unclear how common Crohn's disease might have been before 1932, as it is likely that cases of this disease occurring in an era of limited abdominal surgery may have been mistaken for other processes such as tumor or intestinal tuberculosis. In 1913, Sir Dalziel of Glasgow, Scotland, reported in the British Medical Journal on 13 patients and provided what is now recognized as a classic clinical and pathologic description of Crohn's disease.5 Although not often cited, Dalziel's description predates the one by Crohn et al, and some have argued that the disease should be known by the eponym “Dalziel-Crohn disease.”
After the report by Crohn et al, increased awareness of the disease led to a marked increase in reported cases in the 1930s through the 1950s. The general public's awareness of the disease increased when, in 1956, one of the most famous figures of the 20th century, President Dwight Eisenhower, was diagnosed with Crohn's disease at the terminal ileum. That same year, President Eisenhower underwent intestinal bypass surgery with the small intestine proximal to the area of disease anastomosed to the transverse colon.6 Following this operation, he remained relatively free of symptoms for the remainder of his life.7
Early in the history of Crohn's ...