100 Years of American Gastroenterology100 Years of American Gastroenterology.doc

100 Years of American Gastroenterology: 1900-2000 Joseph B. Kirsner, MD, PhD, DSci (Hon), University of Chicago Medical Center, Chicago, Ill. Medscape General Medicine.?2000;2(1)? The impressive scientific advances made during the 20th century, the reorientation of medical education, and the growth of medical specialization collectively transformed gastroenterology from an empirical clinical activity to an increasingly scientific, procedure-oriented multidiscipline (see Tables 1, 2, 3).[1] Early in this century, access to the digestive tract was limited. Diagnostic and therapeutic resources were scarce. Procedurally, physicians were confined to blood counts and urine analysis, a few blood chemical analyses, gastric aspiration for hydrochloric acid, testing the stools for occult blood (guaiac test slide) and bacterial pathogens, rigid tube proctoscopy, and primitive x-rays of the esophagus, stomach, colon, and gallbladder. Valid concepts of digestive disease were lacking. Visceroptosis, autointoxification, neurasthenia, and dyspepsia were common diagnoses. Todays comprehensive diagnostic capabilities, including fiberoptic endoscopy, biopsies of the esophagus, stomach, small intestine, and colon, x-ray (CT scan)-guided biopsy of the liver and the pancreas, tests of hepatic and pancreatic functions, breath tests, quality x-rays, ultrasonography, computerized abdominal tomography, magnetic resonance imaging, and assessments of gastrointestinal motility and gastrointestinal vascular status were yet to be developed. Therapeutic resources, including blood transfusions, sulfonamides, antibiotics, adrenocortical steroids, immune modifiers, H2 blockers, proton pump inhibitors, anti-inflammatory compounds, nutritional supports, vaccines, cancer chemotherapy, and organ transplantation were unavailable. And abdominal surgery, following the discovery of anesthesia (in 1846) and aseptic technique (1870s), was only in the early stages of development. Important advances occasionally