The Historical Basis of the Idiopathic Inflammatory Bowel Diseases

The “nonspecific” inflammatory bowel diseases (ulcerative colitis, Crohn's disease) initially emerged in single case reports several centuries ago. However, it was not until the latter half of the 19th century that they were recognized as distinct clinical entities. The early history of ulcerative colitis is lost in the obscurity of ancient medicine and the complexities of the infectious colitides. The early history of Crohn's disease is featured in numerous reports of tumor-like inflammatory masses of the abdomen, then regarded erroneously as neoplastic and, at a time of limited abdominal surgery, left untreated. The remarkably descriptive accounts by G. B. Morgagni (1761); S. Wilks (1859); T. K. Dalziel (1913); and B. Crohn, L. Ginzberg, and G. Oppenheimer (1932) highlight the initial inflammatory bowel disease (IBD) literature. These IBD reports also suggest early but understandably limited consideration of several of the current IBD etiologic concepts [microbial, immunologic, nutritional, injurious agents in the fecal stream, and familial (genetic) relationships]. The increasing incidence of patients with ulcerative colitis during the first third to one-half of the 20th century, which has now stabilized, and the increasing numbers of patients with regional enteritis (Crohn's disease) during the second half of the century are consistent with an epidemiologic pattern reflecting environmental etiologic factors.