Pes institute of medical sciences and research Hampton, NJ
Tanishq Kesani, MD1, Pranathi Tella, MBBS2, Yochana Anne, MBBS3, Keerthana Prabhukumar, MBBS4, Anusha Kalluru, MBBS5, Sai Abhinay Reddy Narla, MBBS6, Gitanjali Boppana, MBBS7, Riya Varughese Raju, MBBS8 1Yuma Regional Medical Center, Yuma, AZ; 2Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Karamchedy, Andhra Pradesh, India; 3NRI Institute of Medical Sciences, Vijayawada, Andhra Pradesh, India; 4Indira Gandhi medical college and research institute,puducherry, Trichy, Tamil Nadu, India; 5Pes institute of medical sciences and research, Hampton, NJ; 6Rajiv Gandhi Institute of Medical Sciences,Adilabad, Oswego, IL; 7Andhra medical college, Visakhapatnam, Andhra Pradesh, India; 8Maharajah's Institute of Medical Sciences, Springfield, IL Introduction: Functional bowel disorders like irritable bowel syndrome (IBS) are increasingly diagnosed in clinical practice and frequently overlap with somatic syndromes such as fibromyalgia. These coexisting conditions present diagnostic and therapeutic challenges due to their shared mechanisms, including central sensitisation and gut-brain axis dysfunction. Recent studies underscore the impact of altered gut microbiota and hypothalamic-pituitary-adrenal (HPA) axis dysregulation in perpetuating systemic symptoms. This case highlights the complexity of managing IBS with fibromyalgia in a middle-aged male, emphasising the need for a multidisciplinary, integrative treatment approach.
Case Description/
Methods: A 52-year-old male with controlled hypertension presented with one year of abdominal bloating, cramping pain relieved by defecation, and alternating diarrhoea and constipation. He also reported experiencing postprandial bloating, particularly after consuming FODMAP-rich meals. Over six months, he developed widespread soft-tissue pain affecting the neck, shoulders, back, hips, and thighs, along with morning stiffness, fatigue, cognitive slowing, and non-restorative sleep. Symptoms were stress-sensitive and unrelieved by rest.
Lab evaluation, including CBC, ESR, CRP, TSH, B12, and colonoscopy, was unremarkable, except for vitamin D deficiency (16 ng/mL). Rheumatologic workup was negative. He met Rome IV criteria for IBS-M and ACR 2010 criteria for fibromyalgia.
Management began with a low-FODMAP diet and the use of probiotics. Amitriptyline was replaced by duloxetine (30 mg daily) for persistent pain and fatigue. Melatonin and CBT were added for sleep and stress management, alongside vitamin D supplementation.
At three months, the patient reported moderate symptom relief, improved concentration, better sleep, and a reduction in absenteeism. Discussion: IBS and fibromyalgia share overlapping mechanisms, including gut dysbiosis, central sensitisation, and immune modulation. Reduced levels of Bifidobacteria and Lactobacilli, along with increases in pro-inflammatory microbes, are common in both. This case supports the role of gut-brain-microbiome dysfunction in multisystem disorders. Multimodal therapy targeting both gastrointestinal and systemic pathways can improve outcomes in complex, comorbid presentations.
Figure: Figure 1: Colonoscopy showing normal mucosa with no evidence of inflammation or structural lesions.
Figure: Figure 2: Stool Microbiome Composition Bar Chart: Comparison between control and IBS + Fibromyalgia patient.
Disclosures: Tanishq Kesani indicated no relevant financial relationships. Pranathi Tella indicated no relevant financial relationships. Yochana Anne indicated no relevant financial relationships. Keerthana Prabhukumar indicated no relevant financial relationships. Anusha Kalluru indicated no relevant financial relationships. Sai Abhinay Reddy Narla indicated no relevant financial relationships. Gitanjali Boppana indicated no relevant financial relationships. Riya Varughese Raju indicated no relevant financial relationships.
Tanishq Kesani, MD1, Pranathi Tella, MBBS2, Yochana Anne, MBBS3, Keerthana Prabhukumar, MBBS4, Anusha Kalluru, MBBS5, Sai Abhinay Reddy Narla, MBBS6, Gitanjali Boppana, MBBS7, Riya Varughese Raju, MBBS8. P2970 - Chronic Functional Bowel Disorder with Fibromyalgia in a 52-Year-Old Male: A Case of Persistent Multisystem Symptoms, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
