Inflammatory bowel disease (IBD) comprises the group of conditions identified by a tendency for chronic or recurring immune activation and inflammation within the gastrointestinal tract. The two major entities within the spectrum of IBD are Crohn’s disease and ulcerative colitis, two distinct syndromes with divergent treatment and prognosis.
Crohn’s disease derives its name from a publication by Crohn et al in 1932 that first called attention to the terminal ileitis as a distinct and chronic entity, however the characteristic description of intestinal inflammation dates back as far as Morgagni in 1871.
Crohn’s disease is a condition of chronic inflammation involving the gastrointestinal tract from mouth to anus, with a propensity for the terminal small bowel and proximal large bowel (ileocecal disease). Inflammation is classically discontinuous but may involve all levels of thickness (mucosa to serosa). The cardinal symptoms are diarrhea, abdominal pain, and weight loss. Extraintestinal manifestations can include joint involvement (pauciarticular arthropathy), ophthalmological involvement (episcleritis, uveitis), dermatological findings (erythema nodosum), oral findings (aphthous ulcers), but are not exclusive to these. The etiology is not completely understood and therapy is not curative, rather targeted at controlling the disease.
Ulcerative colitis was first described by Dr Samuel Wilks, in 1859. Dr. Wilks lectured on a “simple idiopathic colitis” and later described a patient with the disease. The first complete description was given by Sir Arthur Hurst in 1909 who described endoscopic findings and gave a clear differentiation form bacillary dysentery.
Ulcerative colitis is an inflammatory disorder that affects the rectum and extends proximally to involve the colon to a variable extent. Ulcerative colitis has been considered an autoimmune disease with an increased association to other autoimmune disorders (thyroid disease, diabetes, pernicious anemia). The cardinal symptoms of ulcerative colitis include diarrhea, rectal bleeding, passage of mucus, and abdominal pain. Symptoms may be present for weeks to months, and this slow insidious onset is characteristic of the disease. Extraintestinal manifestations can include joint involvement (acute arthropathy), ophthalmological involvement (uveitis), dermatological findings (erythema nodosum), liver disease (primary sclerosing cholangitis), oral findings (aphthous ulcers) and thromboembolism (increased factor V Leiden mutation).
