Functional Bowel Syndrome: Also a “Crohn” Disease?

Burrill R. Crohn (1884–1983), a pioneering gastroenterologist, is best known for a manuscript published in 1932 in the Journal of the American Medical Association, coauthored with Leon Ginzburg and Gordon Oppenheimer entitled ‘‘Terminal Ileitis: A New Clinical Entity’’ [2]. In this publication, he described 14 cases of a granulomatous inflammation of the distal ileum. Although descriptions of the condition had arguably been published previously, this landmark paper described clinical findings in the largest group of patients with inflammatory bowel disease at that time, and was the source of our current use of the author’s name for the disease. Dr. Crohn was an interesting man who practiced medicine into his 90s, primarily at the Mount Sinai Hospital in New York, where he worked for over 40 years. A true polymath, he also painted and studied Civil War history. Like many of his contemporaries, who worked when the field of gastroenterology was still in its infancy, his career was devoted to the understanding and management of a variety of vexing conditions, including peptic ulcer disease, gastrointestinal cancer, and functional bowel disorders. Dr. Crohn’s premise underlying his description of functional bowel disorders, republished in this issue of Digestive Diseases and Sciences [1], is that the gastrointestinal tract is a target for ‘‘external forces’’ including stress, personal problems, and family history that ultimately predispose to the development of what Dr. Crohn termed the ‘‘neurotic stomach.’’ Based on contemporary understanding of functional bowel disorders, this expression has a certain quaintness, as it reflects the prevailing interest in psychoanalytic theory. At the time of this manuscript’s publication, Sigmund Freud’s picture had already appeared on the cover of Time, and Freud’s name comes up twice in the article, beginning with its introductory sentence. Although our current understanding of functional bowel disorders includes a number of more recently appreciated non-psychiatric factors associated with the pathophysiology of these conditions, including intestinal dysbiosis, dysregulated gastrointestinal neurotransmitters, and distorted brain-gut activities, Dr. Crohn’s article contains many insights that remain relevant to the care of these patients in the twenty-first century. The article begins by suggesting that the burden of functional gastrointestinal (GI) conditions exceed that of the other major classes of organic diseases affecting the GI tract recognized at that time (ulcers, gallbladder disease, and cancer). Of interest, current literature supports this premise. In 2008, an annual total of 11,648,000 ambulatory care visits for functional gastrointestinal disorders in the United States occurred, compared with 7,578,000 visits for the other three GI conditions combined [3]. Dr. Crohn goes on to describe organic gastrointestinal disorders as having a basis in either secretory or motor abnormalities. Although we would certainly agree with the definition of ‘‘true cardiospasm’’ (achalasia) or gastric atonia as organic motor disorders, our lines today would be blurred in terms of defining these as functional versus organic disorders. On the other hand, we would likely not classify disorders of suspected psychiatric etiology, such as rumination syndrome or anorexia nervosa, as intrinsic gastrointestinal motor diseases, while we would recognize associated motility disturbances. The original article Functional and nervous disorders of the stomach and alimentary tract by Burrill B. Crohn published in American Journal of Digestive Diseases and Nutrition, October 1934, Volume 1, Issue 10, pp. 773–777. Springer.