The dawn of the small bowel expert cometh!

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The history of gastroenterology is an interesting one and bears a close relationship with ‘what we eat’ and our diet. The earliest known representation of the gut is c. 30000 BC in a Paleolithic cave painting in Lascuax and depicts loops of bowel spilling out from where a spear has penetrated a bison [1]. From there on dietary hygiene is mentioned in the Bible (c. 2500 BC Old Testament) and onwards and upwards through Egyptian, Greek and Babylonian societies [1]. Although the gut in medicine is a continuous source of interest and investigation – contemporary gastroenterological practice has not always focussed on the small bowel. We have had phases of interest and expertise with upper Gastrointestinal (GI) (with the boom of H. Pylori in the 1980s), Inflammatory Bowel Disease, Hepatology and Endoscopy. Clinicians will declare themselves as having an expertise in any of these fields but beyond the sub-speciality of Nutrition there has been less focus on the small bowel. Why would this be? Rigid Endoscopy has been repeatedly attempted throughout history but it was the advent of fibre-optics (in the 1950s) that brought us the modern day endoscope. This is credited jointly to Basil Hirschowitz and Larry Curtiss in the United States and concurrently Harold Hopkins in the United Kingdom [1]. However, because of its length and untethered nature the small bowel remained elusive and I would perhaps controversially suggest that Gastroenterologists of that time took an approach of ‘If I can’t see it or reach it with an endoscope then I won’t study it too closely!’.
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