Crohn's disease

A subacute and chronic inflammatory disease with symptoms variable according to anatomic location and amount of involvement. It was originally believed to be limited to the terminal ileum, but subsequently recognized as involving other parts of the intestine, especially the distal ileum, colon, and anorectal region. Abdominal pain and cramps may indicate narrowing of the lumen and partial obstruction of the intestine. Associated with abscesses and fistulas. Etiology unknown. Slight prevalence in males, Jewish people most frequently affected. Onset at any age; average 25 years.

The first reported case of granulomatous enterocolitis is ascribed to Giovanni Battista Morgagni (1682-1771), who discussed the clinical course in a 20 year old man with a protracted, sometimes bloody diarrhoea and colic pains. The patient died from a perforation of the terminal ileum.

Another case was described in Sweden by John Berg at the Serafimerlasarettet in Stockholm in 1898 (John Wilhelm Berg, 1851-1916?) and yet another by Antoni Lesniowsky from Warsaw in 1904. At the 1913 meeting of the British Medical Association, the Scottish physician T. Kennedy Dalziel in a lecture reported nine cases of disseminated thickening of, in most cases, the distal small intestine but in some cases also of the right colon.

The American clinician and pathologist Eli Moschowitz (1879-1964) and A. O. Wilensky of the Mount Sinai Hospital in New York in 1923 published a work titled "Non-specific granulomata of the intestine". They described a case with non-specific intestinal granulomas, thickening of the distal ileum, as well as an intestine to skin fistula.

At a meeting of the American Medical Association in New Orleans on May 13, 1932, Burrill Bernard Crohn, Leon Ginzburg, and Gordon Oppenheimer delivered a lecture titled "Terminal ileitis: A new clinical entity". They reported 14 cases of a granulomatous inflammation of the distal ileum. J. A. Bargen, in a contribution protested the designation "terminal" ileitis. He maintained that, as most of the patients had survived, the term "terminal" was inappropriate. He suggested that the disease instead be termed "regional ileitis". Crohn and his associates accepted this view and, when the work was published later that year, the article was titled “Regional ileitis; a pathologic and clinical entity". Of the three original authors Ginsburg and Oppenheimer were the most experienced, but Crohn's name, for "alphabetic reasons", appeared the first on the publication.

This was the first time this condition was reported i a larger, widespread journal, and the article thus received a lot of attention. During the following years a multitude of descriptions, of single cases or series of cases, were published. It was soon obvious that the disease did not only affect the distal ileum, but also other parts of the gastro-intestinal tract.

• A. Lesniowski.
  Przyczynek do chirurgii kiszek.
  Medycyna, Warsaw, 1903, 31: 460-464, 483-489, 514-518.
• B. B. Crohn, L. Ginzburg, G. D. Oppenheimer:
  Regional ileitis; a pathologic and clinical entity.
  Journal of the American Medical Association; Chicago, 1932, 99: 1323-1329.