The changing faces of Crohn's disease and ulcerative coiitis
Posted on 11/11/2011
There are few diseases which have changed faces to such an extent as the inflammatory bowel diseases, i.e. ulcerative colitis (UC) and Crohn's disease (CD)
The changing faces of Crohn's disease and ulcerative coiitis
ANDERS EKBOM
There are few diseases which have changed faces to such an extent as the inflammatory bowel diseases, i.e. ulcerative colitis (UC) and Crohn's disease (CD). At the beginning of the 20th century inflammatory bowel disease (IBD) was a rarity, and at the end of the same century these disease entities were something gastroenterologists in the Westernized world encounter not once, but repeatedly, on a daily basis. Fifty years ago high socioeconomic status and Jewish ethnicity were two commonly accepted risk factors, associations that today are either questioned or have been refuted in observational studies. Pancolitis, in the case of UC and CD confined to terminal ileum, were the most common clinical features during the first part of the 20th century as opposed to today. Nowadays ulcerative proctitis is the most common clinical presentation among UC patients and CD confined to the terminal ileum constitutes a minority of CD patients. Geographically there was a north-south gradient; a finding reproduced in different settings and continents that does not seem to exist today. Instead, we can see the emergence of an eastwest gradient. A hypothesis of the origin of the diseases included Mycobacterium paratuberculosis as a potential agent, a hypothesis that was refuted early on, then reintroduced, and later refuted again. These different faces of the two diseases are probably in part due to bad methodology or science, but this also illustrates that the two diseases have changed faces over time. It is a rather straightforward endeavor to describe the different faces over time, as we are fortunate to have clinicians and epidemiologists who, during the past 100 years, have taken a great interest in IBD. The difficult part is to interpret these findings and to make sense of them. The goal is to provide benchmarks for other scientists, which can be used to test the different hypotheses, which will emerge. This way we will eventually understand the etiology of IBD and primary prevention will become a possibility.
Stephan R. Targan, Fergus Shanahan andLoren C. Karp (eds.), Inflammatory Bowel Disease: From Bench to Bedside, 2nd Edition, 5-20.
© 2003 Kluwer Academic Publishers. Printed in Great Britain
