Crohn’s disease, irritable bowel syndrome, and chronic fatigue: the importance of communication and symptom management—a case report

Table 2 Course of patient’s symptoms, based on available medical reports and patient’s self-disclosure. CD, Crohn’s disease; IBS-D, irritable bowel syndrome with diarrhea; CFS, chronic fatigue syndrome; ICR, ileocecal resection. Differentiation: CD-like symptoms [2], IBS-D-like symptoms [6, 33], and CFS-like symptoms [49, 85]

Time sections → symptoms (grouped in chronological order of occurrence)↓	Likely attributable to	A 10/1980–12/1980	B 01/1981–02/1981	C 03/1981–02/1982	D 03/1982–06/1985	E 07/1985–06/2006	F 07/2006–12/2016	G 01/2017–02/2019	H 03/2019–02/2022	I 03/2022–12/2023	J 01/2024–06/2024
Abdominal pain after meals	CD	×	×
Bowel movements	CD, IBS-D	4–6/day	6–8/day	4–5/day	1–3/day¹	1–4/day²	3–4/day³	4–5/day	4–6/day	2/day⁴	2/day⁴
Diarrhea	CD, IBS-D	4–6/day	6–8/day	3–4/day	0–2/day¹	0–3/day²	1–2/day³	2–3/day	3–4/day	0/day⁴	0/day⁴
Weight loss	CD	×	×
Abdominal pain, persistent	CD		×
Fever	CD		×
General fatigue	CD, IBS-D		×					2–3 weeks/2 months	2–3 weeks/month	1 week/3 months
Iliopsoas abscess	CD		×
Ileocolitis (Crohn’s colitis)	CD		ICR	In remission	In remission	In remission	In remission	In remission	In remission	In remission	In remission
Low-grade ileitis	(CD)				09/1984	01/1991	09/2006
Low-grade colitis	(CD)					06/1986
Abdominal pain, intermittent	IBS-D							(×)	×	(×)
Flu-like symptoms	CFS							2–3 weeks/2 months	2–3 weeks/month	1 week/3 months	1 week/6 months
Hypertension	(IBS)⁵							×	×	× ⁶	× ⁶
Urinary urgency	IBS-D, CFS							×	×	×	(×)
Arthralgia (hip joint pain)	CFS								×	×	(×)
Bloating with abdominal pain	IBS-D								2–3 weeks/month	1 week/3 months	(×)
Brain fog, dizziness, poor memory	CFS								×	(×)
Extreme tiredness	CFS								×	(×)
Headache	CFS								×	(×)	(×)
Insomnia, unrefreshing sleep	CFS								2–3 weeks/month	1 week/month	2–3 days/month
Post-exertional malaise	CFS								×	(×)	(×)
Temperature dysregulation	CFS								2–3 weeks/month	×	(×)

A symptoms onset; B severe symptoms; iliopsoas abscess removed, ileocecal resection; C first year after surgery; D begin cholestyramine intake; E begin loperamide intake; F assuming a highly demanding position in 07/2006; G medical leave in 07/2017; H severe gastointestinal infection in 03/2019; I complementary medicine intervention at UZN Freiburg in 02/2022; J begin L-glutamine intake
¹Exception in 09/1984: BM 4–5/day, diarrhea 3–4/day
²Exceptions in 06/1986: BM 4/day, diarrhea 3–4/day and in 01/1991: BM 4–6/day, diarrhea 4–6/day
³Exception in 09/2006: BM 3–4/day, diarrhea 2–4/day
⁴Only on 2–3 days/month: BM 3–4/day, diarrhea 1–2/day
⁵Hypertension has been found to be associated with IBS [86]
⁶Now well under control. (×) symptoms mild, further decreasing and/or less frequent

ISSN: 1752-1947