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Published in Gastroenterology
· August 01, 2022

Crohn’s Disease: An Overview and History
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Crohn’s disease is a chronic inflammatory disorder of the intestines. It can occur anywhere from your mouth to your anus but classically in the small and large intestines. That is related to a variety of factors, including potentially gut dysbiosisgut dysbiosis, some environmental impact, modifiable and immodifiable factors, and imbalance in your gut microbiome potentially, and dysregulated immune system, chronic inflammation.

Essentially, initially, most elegantly described, I should say, in the late 1920s, by Dr. Burrill Crohn, out of New York, who had discussed this. And if you actually go back and look in the literature there’s been, up into the 1800s even, people talking about chronic inflammation in the ileocecal region, your small intestine and your large intestine. And that was just the beginning foray into understanding what Crohn’s disease first was. This actually moved on. Our understandings improved thousand-fold from just the initial descriptions of terminal ileitis or ileal colonic inflammation.

Symptoms, diagnosis, and effects

Crohn’s disease most accurately, probably, comprises a spectrum of chronic inflammatory disorders of the small intestine. And we describe Crohn’s disease by location, behavior, and potentially even age of diagnosis. And, we’re finding out more and more about bowel damage. And so, patients that get diagnosed typically fall into whether or not their symptoms are primarily related to an inflammatory component disease. Chronic inflammation can lead to stricturing or narrowing in intestinal mucosa, and even potentially fistular connections, ideally between various parts of the intestines, including small intestine and large intestine, and causing infectious complications in the abdomen, or even perhaps, as some of you may be aware of, obviously, the perirectal fistulizing component.

So, to bring that highlight into play, fistulizing penetrating Crohn’s disease in the perirectal fistula causing abscesses is considered Crohn’s just as is small aphthous ulcers that we may see in the small wall in the right colon maybe considered Crohn’s. So, our understanding has kind of progressed to the point where we want to identify the right patients for the right therapies at the right time. And, while we all reach back into our armamentarium of being great diagnosticians, we have some signs and symptoms that can be helpful, but they aren’t the whole gambit here.

So, many patients have not necessarily even the rectal bleeding and diarrhea but could just have fatigue, abdominal pain, weight loss, anemia, and other things that could potentially be a sign of Crohn’s disease at a variety of ages. Typically, see patients in their twenties and thirties, young productive individuals, and the prevalence is growing. And, while initially thought to be a disease of the Western developing world, we are seeing this all throughout the world, and approximately, in the US, some of the most recent estimates, up to about almost 3 million patients suffer from Crohn’s disease. And so, it’s an area that has required a lot of work.

G Mohan