Table 1 Timeline: patient’s symptoms, diagnoses, treatment, and significant events, based on available medical reports and patient’s self-disclosure

10/1957–04/1958

0–1/2

Diarrhea at age 4–12 weeks

Unknown

11/1957: Breast feeding ends at age 6 weeks (diarrhea)

After birth, patient is transferred to a baby nursing home for 6 months; reportedly crying most of the time, refusing food

1958–1966

1–9

frequent colds, otitis media, coughing; eczema from red currants and rhubarb

Asthma, dermatitis

Antibiotics

02/1966: Tonsillectomy; 04/1966: 6 weeks at a North Sea sanatorium

04/1966: Patient admitted to children’s sanatorium on the North Sea for 6 weeks (“deported child”) where he like many other children suffers psychological and physical violence

10–12/1980

23

Diarrhea 4–6/day; intermittent, then abdominal pain

Weight loss 16 kg within 4 months (now 62 kg, 176 cm)

Duodenal ulcer (suspected)

19 Dec 1980: Cimetidine 200 mg PO qid

Pre-graduate exams (chemistry); persistent diarrhea, abdominal pain after food intake; symptoms alleviate during physical exercise. OGD, U/S; ESR, complete blood count and all other laboratory results normal

02/1981

23

Diarrhea 6–8/day; increasing pain in right lower abdomen; body temp. > 39 °C (102 °F)

Crohn’s disease, ileocolitis, iliopsoas abscess

Exploratory open surgery, iliopsoas abscess drained;

Open abdominal surgery, ileocecal resection

Sulfasalazine 2 g PO qd

26 Feb 1981: Open abdominal surgery, conglomerate of caked intestinal loops removed: 42 cm terminal ileum, 10 cm cecum; histology: transmural inflammation, epithelioid granulomas

03/1981–02/1982

23–24

Diarrhea 3–4/day

Crohn’s disease, in remission; chologenic diarrhea

Sulfasalazine 2 g PO qd

03/1981: Parenteral diet; weight 56 kg

04/1981: Patient resumes studies while still hospitalized

05/1981: Wt 60 kg

Diet: Oatmeal, toast, rusks, banana, white rice, steamed potatoes, carrots

10/1981: Outpatient examination at Freiburg University Medical Centre. U/S, X-ray Sellink, ESR, complete blood count and all other laboratory results normal; weight 65 kg

Semi-annual ESR and complete blood count results are normal

03/1982

24

Diarrhea 0–1/day

Crohn’s disease, in full remission; gallstones, chologenic diarrhea

Cholestyramine 2 g PO tid

U/S, X-ray Sellink, ESR, complete blood count and all other laboratory results normal; weight 67 kg

09/1984

26

Diarrhea 3–4/day

Crohn’s disease, mild activity; gallstones, chologenic diarrhea

Cholestyramine 2 g PO tid; sulfasalazin 2 g PO qd; steroids temporarily

Colonoscopy, histology: slight nonspecific inflammation in ileal mucosa

U/S, X-ray Sellink, ESR, complete blood count, and all other laboratory results normal. BM 4–5/day; weight 67 kg

07/1985–10/1985

27

None

Crohn’s disease, in full remission; chologenic diarrhea

Cholestyramine 2 g PO tid; loperamide HCl 2 mg PO qd (self-medication); cyanocobalamin 1000 µg IM q3mos

Low vitamin B12; weight 67 kg

Trial and error-based vegetarian diet, for details see “Medical and lifestyle interventions” section

06/1986

28

Diarrhea 3–4/day; upper abdominal pain

Crohn’s disease with low-grade chronic colitis; chologenic diarrhea; gastroduodenitis

Cholestyramine 2 g PO tid; loperamide HCl 2 mg PO qd; cyanocobalamin 1000 µg IM q3mos; steroids temporarily

Colonoscopy, histology: low-grade chronic colitis, low-grade chronic proctitis. OGD: moderate acute and chronic gastro-duodenitis

U/S, X-ray Sellink, ESR, complete blood count and all other laboratory results normal; weight 64 kg

07/1986–08/1990

28–32

Diarrhea 1–2/day; upper abdominal pain

Crohn’s disease, with low-grade chronic colitis; chologenic diarrhea

Cholestyramine 2 g PO tid; loperamide HCl 2 mg PO qd; cyanocobalamin 1000 µg IM q3mos

Semi-annual ESR and complete blood count results are normal, weight 64–67 kg

Patient consults various gastroenterologists as to why diarrhea persists even though Crohn’s disease is in remission. General response: Reasons are unknown but your condition should actually be better

04/1989: Patient accepts position at a Federal Food Investigation Agency

01/1991

33

Diarrhea 4–6/day; upper abdominal pain

Crohn’s disease with low-grade ileitis; cholecystolithiasis; chologenic diarrhea;

Continued

Colonoscopy, histology: low-grade nonspecific ileitis

U/S, ESR, complete blood count and all lab results normal except elevated ALT, AST, and gammaGT, BM 4–6/day; weight 67 kg

The more frequent diarrhea was explained by bile acid loss syndrome and a stress-related functional component

02/1992–07/1995

34–37

Diarrhea 1–3/day; upper abdominal pain

Crohn’s disease in remission; cholecystolithiasis; chologenic diarrhea

Continued

04/1992: Laparoscopic cholecystectomy

Semi-annual ESR and complete blood count results are normal. BM 3–4/day; weight 70 kg

10/1995–06/2006

38–49

Diarrhea 1–2/day

Crohn’s disease, in remission; chologenic diarrhea

Continued

Semi-annual ESR and complete blood count results are normal. BM 3–4/day; weight 72 kg

Patient consults various gastroenterologists as to why diarrhea persists even though Crohn’s disease is in remission. General response: Reasons are unknown but your condition should actually be better

07/2006–10/2007

49–50

Diarrhea 2–4/day;

more often cold symptoms

Crohn’s disease with low grade ileitis; chologenic diarrhea; lactose intolerance

Continued

09/2006: Prednisolone 20 mg PO qd × 4 weeks, then reduced weekly by 2.5 mg PO qd

07/2006: Patient assumes a demanding position at a European Union research institution

Semi-annual ESR and complete blood count results are normal. BM 3–4/day; weight 72 kg

09/2006: Colonoscopy, histology: low-grade nonspecific ileitis

05/2007: Abdominal MRI: normal findings. Lactose intolerance test: positive result

2008–2011

49–55

Diarrhea 1–2/day

Crohn’s disease in remission; chologenic diarrhea; lactose intolerance

Cholestyramine 2 g PO tid;

loperamide HCl 2 mg PO qd; cyanocobalamin 1000 µg IM q6mos

Patient’s work is highly demanding. Patient is bullied by a superior

Annual ESR and complete blood count results are normal. BM 3–4/day; weight 74, increasing to 76 kg

2012–2016

54–59

Diarrhea 1–2/day

As before, new diagnosis: hypertension

Continued, in addition ramipril 5 mg PO qd;

05/2012: Colonoscopy: no signs of inflammation in neoterminal ileum and colon

Patient is increasingly bullied by a superior

Annual ESR, CRP, and complete blood count results are normal. BM 3–4/day; weight 76, increasing to 80 kg

2017–2018

60–61

Diarrhea 2–3/day, belly pain;

6 × annually flu-like symptoms for 2–3 weeks, general fatigue, urinary urgency

As before

Continued

Patient feels hardly sociable, often cannot keep appointments; takes light diet. Bullying by superior intensifies in 01–06/2017

07/2017: Medical leave due to deteriorating state of health

BM 4–5/day; weight 82 kg

03/2019–01/2022

62–64

Diarrhea 3–4/day, bloating with belly pain; general fatigue, insomnia, flu-like symptoms 1/month for 2–3 weeks, strong unilateral hip joint pain

As before

Continued, in addition self-medication with probiotics

03/2019: Patients suffers an intestinal infection with vomiting diarrhea

Frequent flu-like symptoms after exposure to cool air and moderate physical exercise, 1/month for 2–3 weeks: diarrhea and bloating with abdominal pain, general fatigue, insomnia; headache, brain fog, dizziness, poor memory, extreme tiredness (preceding BM); cold extremities, disturbed thermoregulation, urinary urgency, hypertension. Strong, unilateral hip joint pain since 11/2020. Probiotic bacteria trials prove ineffective

Patient feels no longer sociable, makes no appointments; takes light diet

08/2019: Colonoscopy: no inflammation in neoterminal ileum and colon

04/2020: Early retirement for health reasons

09/2021 MRT and 11/2021 X-ray: Bilateral age-related low-grade hip osteoarthritis not explaining pain

11/2021: Crohn’s disease activity index (CDAI) [32]: 183 points

Patient consults various specialists in gastroenterology, internal medicine, psychosomatics and nutrition as to why his symptoms persist even though Crohn’s disease is in remission. General response: Frequent colds are attributed to a weakened immune system due to stress

Annual ESR, CRP, and complete blood count results are normal. BM 4–6/day; weight 85 kg

02/2022

64

Diarrhea 3–4/day, bloating with belly pain, insomnia, general fatigue;

flu-like symptoms 1/month for 2–3 weeks; strong bilateral hip joint pain

As before,

suspected secondary IBS

Tinctura Opii 6 gtts (3 mg anhydrous morphine) PO bid instead of loperamide. Otherwise continued

Patient consults a specialist in internal medicine, gastroenterology, and complementary medicine

Start with multimodal complementary medicine intervention

Explanation of symptoms by disturbance of the vegetative nerve system (sympathetic–parasympathetic, gut–brain axis, disturbed thermoregulation)

Patient is advised of the following:

1. Tinctura Opii to reduce bowel motility

2. Light dinner should be taken early

3. Moderate physical exercise (HR < 130 bpm, pacing); relaxation techniques

Patient experiences a calming positive effect by receiving an explanation for the symptoms experienced for the first time in more than 40 years

03/2022–12/2023

64–66

Diarrhea 1–2/day with bloating on 2–3 days/month;

flu-like symptoms

3–4/year for 1–2 weeks; strong bilateral hip joint pain

As before, suspected CFS

As before, in addition lavender oil 80 mg PO bid;

01/2024: 16 mg candesartan cilexetil / 5 mg amlodipine PO qd instead of ramipril; methyl cobalamin 500 µg ODT biw instead of cyanocobalamin

Patient experiences massive improvement in life quality, sociability is regained; flights to North America and Asia for the first time in 5 years

Frequency of described symptoms significantly reduced; diarrhea, bloating, abdominal pain still occur after acute stress or physical exertion, and after exposure to cold air. Insomnia, headache, brain fog, dizziness, poor memory, extreme tiredness prior to BM, strong bilateral hip joint pain persists, yet frequency and intensity were noticeably reduced

Trial and error-based vegetarian diet, for details see “Medical and lifestyle interventions” section

ESR, CRP, complete blood count normal. BM 1–2/day; weight 80 kg

01/2024–06/2024

66

Diarrhea 1–2/day with bloating on 2–3 days/month; flu-like symptoms 3–4/year for 1–2 weeks; mild unilateral hip joint pain

As before

Continued, in addition L-glutamine 5 g PO qd × 1 week, 10 g PO qd × 1 month, then 10 g PO bid

Further stabilization and partial disappearance of symptoms experienced since 03/2019. Diarrhea, bloating may occur after acute stress or physical exertion, now mildly and generally without abdominal pain; insomnia 2–3 days/month; no general fatigue, brain fog dizziness, poor memory or extreme tiredness. Only mild unilateral hip joint pain

06/2024: Crohn’s disease activity index (CDAI) [32]: 87 points

ESR, CRP, complete blood count normal. BM 1–2/day; weight 81 kg