The continuing advancements in medical training and treatments have saved countless lives and made countless more lives better; but, some illnesses remind us of how much we still have to learn. A good example of this is found in Crohn’s disease, which is often thought of as a disease more relevant to the modern era of medicine because of the ever-increasing prevalence.
However, Crohn’s has been around for quite a while, with sometimes fatal consequences.
A 2015 study in Autops Case Rep notes that, as far back as the 1st Century, celebrated Greek physician Aretaeus of Cappadocia described the case of a young man with chronic and recurring abdominal illness. Many regard this as the first recorded case of Crohn’s disease.
Who knows how many other similar cases occurred in the following centuries? But fast-forwarding to the 10th Century, historical notes would suggest that English King Alfred the Great had what was described as a typical enteritis, but also with an abscess and anal fistula, which is of course one of the more troublesome potential complications of Crohn’s. His biographer, Asser, described him as “the stricken monarch”. An article in the Journal of the Royal Society of Medicine stated that Alfred had “an externally visible peri-anal condition, an illness that Asser said the king had ‘from the first flowering of his youth’”. It’s reported that Alfred prayed to God to replace his fistula with a different illness, on the understanding that the new illness would not be visible. This suggests that stigma around inflammatory bowel disease (IBD) is not a new phenomenon either.
One of the problems with assessing how long Crohn’s has been around is the fact that in centuries gone by, it could easily be lost in a soup of other illnesses and comorbidities.
However, these early accounts are highly suggestive of IBD. Even before Alfred, Florentine physician and pioneer in autopsy medicine Antonio Benivieni described the multi-ulcerated small intestine in a patient who died after a long dysentery-like disease.
Moving on to 1761, Giovanni Battista Morgagni – widely regarded as the father of modern anatomical pathology – described a 20-year-old man with typical regional ileitis who died in his care. From the autopsy, Morgagni described lesions we now know are typical of Crohn’s disease. These lesions affected both the small and large intestine, including erosions, ulcerations, and perforations with lymphadenopathy. The list goes on, all leading up to groundbreaking work in 1932.
That year, a group of clinician-researchers at the Mount Sinai Hospital in New York published the seminal paper titled ‘Regional ileitis: A pathological and clinical entity’. This described 14 patients with symptoms and surgical intestinal abnormalities, which researchers recognised as a singular entity. Drs Burrill B Crohn, Gordon Oppenheimer, and Leon Ginzburg later coined the term ‘Crohn’s disease’ and the rest, as they say, is history.
At least in the modern era, we have the chance of early diagnosis. Pharmacists, nurses, and other healthcare professionals are improving their education on IBD, and will become more instrumental in flagging the symptoms and referring an individual for assessment in a clinic. This will be vital for the estimated 40,000 people in Ireland suffering with an IBD.
Financial stress has also emerged as a challenge for Crohn’s sufferers. Just last year, Crohn’s and Colitis Ireland revealed that 62 per cent of people with IBD found the financial impact to be a “significant burden”. These patients spend an average of €3,264 each year on just managing their condition, with costs including treatment, medications, dietary needs, lost wages, travelling expenses, insurance, and other costs. This has led to calls for the recognition by policymakers of IBD as a long-term illness to ease the financial burden on these patients.
But ‘we are where we are’. No doubt Alfred and others like him would have given their kingdom for a proverbial horse, in the form of our modern treatments. Perhaps in another hundred years, treatment for IBD will be a matter of a simple vaccination.
But for now, the challenges of aetiology, prompt diagnosis, symptom control, and the financial issues mean managing this age-old condition remains a complex task.
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