Inflammatory bowel disease after 1932.

The clinical diseases of ulcerative colitis (UC) and Crohn's disease (CD) were defined by 1932-1933. After that, the major conceptual developments were the recognition that regional enteritis could clearly involve the colon, and that cancer and toxic megacolon could occur in both CD and UC. In the last half of the 20th century the main thrust of gastroenterology at The Mount Sinai Hospital has been in inflammatory bowel disease (IBD), with contributions to extra-intestinal manifestations, measurement of clinical activity in CD, the natural history of the placebo arm of controlled trials, complications and therapy with corticosteroids, 5-ASA, 6-mercaptopurine, immunomodulators and cyclosporine. Actuarial life tables were introduced for postoperative recurrence and re-operation rates, as well as for quality of life analysis. Two forms of CD were defined, perforating and non-perforating, and the role of the fecal stream was explored in light of the higher risk of recurrence after operations with anastomosis as compared with ileocolostomy.