Haedrich Johannes, Huber Roman
Center for Complementary Medicine, Department of Internal Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany.
J Med Case Rep. 2025 Jan 9;19(1):9. doi: 10.1186/s13256-024-05010-3.
Crohn's disease and irritable bowel syndrome may both cause abdominal pain and diarrhea. Irritable bowel syndrome not only is an important differential diagnosis for Crohn's disease but also occurs in one out of three patients with Crohn's disease in remission in parallel. If not adequately diagnosed and treated, additional functional symptoms such as fatigue and/or muscle pain may develop, indicating a more severe course.
A 64-year-old Caucasian male with long-standing, widely inactive Crohn's disease presented with persistent diarrhea, bloating, abdominal pain, general fatigue, unexplained hip pain, and frequent shivering with cold extremities, which had worsened following a gastrointestinal infection and psychological stress. A plausible explanation of his symptoms, based on an understanding of mind-body interactions, the autonomic nervous system, and temperature regulation, combined with symptom relief, was associated with rapid and sustainable improvement. After 2.5 years of follow-up, the patient is almost symptom-free.
This case report exemplifies the interrelation between organic (Crohn's disease) and functional diseases (irritable bowel syndrome, chronic fatigue syndrome, and somatoform pain). It further demonstrates that these connections may be overlooked in daily practice and that providing a plausible explanation in combination with symptom relief may be important for patients with functional syndromes.
克罗恩病和肠易激综合征均可引起腹痛和腹泻。肠易激综合征不仅是克罗恩病的重要鉴别诊断疾病，而且在三分之一处于缓解期的克罗恩病患者中同时存在。如果未得到充分诊断和治疗，可能会出现疲劳和/或肌肉疼痛等额外的功能症状，提示病情更为严重。
一名64岁的白种男性，患有长期广泛静止期的克罗恩病，出现持续腹泻、腹胀、腹痛、全身疲劳、不明原因的髋部疼痛以及频繁寒战伴四肢发冷，这些症状在胃肠道感染和心理压力后加重。基于对身心相互作用、自主神经系统和体温调节的理解，并结合症状缓解，对其症状的合理阐释与快速且持续的改善相关。经过2.5年的随访，该患者几乎无症状。
本病例报告例证了器质性疾病（克罗恩病）与功能性疾病（肠易激综合征、慢性疲劳综合征和躯体形式疼痛）之间的相互关系。它进一步表明，这些联系在日常实践中可能被忽视，并且为功能性综合征患者提供合理的解释并缓解症状可能很重要。
