Advances in the medical management of bowel endometriosis

Vercellini, Paolo; Sergenti, Greta; Buggio, Laura; Frattaruolo, Maria Pina; Dridi, Dhouha; Berlanda, Nicola

doi:10.1016/j.bpobgyn.2020.06.004

Cited by 25 publications

(24 citation statements)

References 73 publications

(154 reference statements)

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“…That increased CA125 concentrations return to normal after endometriosis excision suggests these are a consequence of endometriosis. That decreased NK activity [ 24 ] and increased pregnancy complications [ 25 ] do not change after surgery, suggesting they are pre-existing to endometriosis. The G-E pathogenesis also explains that deep endometriosis can occasionally initiate and develop many years after menopause in women not taking estrogens ( Figure 1 ) [ 11 ].…”

Section: New Understanding Of Pathophysiologymentioning

confidence: 99%

New Understanding of Diagnosis, Treatment and Prevention of Endometriosis

Amro

Aristondo

Al-Suwaidi

et al. 2022

IJERPH

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For 100 years, pelvic endometriosis has been considered to originate from the implantation of endometrial cells following retrograde menstruation or metaplasia. Since some observations, such as the clonal aspect, the biochemical variability of lesions and endometriosis in women without endometrium, the genetic-epigenetic (G-E) theory describes that endometriosis only begins after a series of cumulative G-E cellular changes. This explains that the endometriotic may originate from any pluripotent cell apart from the endometrium, that ‘endometrium-like cells’ can harbour important G-E differences, and that the risk is higher in predisposed women with more inherited incidents. A consequence is a high risk after puberty which decreases progressively thereafter. Considering a 10-year delay between initiation and performing a laparoscopy, this was observed in the United Arab Emirates, Belgium, France and USA. The subsequent growth varies with the G-E changes and the environment but is self-limiting probably because of the immunologic reaction and fibrosis. That each lesion has a different set of G-E incidents explains the variability of pain and the response to hormonal treatment. New lesions may develop, but recurrences after surgical excision are rare. The fibrosis around endometriosis belongs to the body and does not need to be removed. This suggests conservative excision or minimal bowel without safety margins and superficial treatment of ovarian endometriosis. This G-E concept also suggests prevention by decreasing oxidative stress from retrograde menstruation or the peritoneal microbiome. This suggests the prevention of vaginal infections and changes in the gastrointestinal microbiota through food intake and exercise. In conclusion, a higher risk of initiating endometriosis during adolescence was observed in UAE, France, Belgium and USA. This new understanding and the limited growth opens perspectives for earlier diagnosis and better treatment.

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Section: New Understanding Of Pathophysiologymentioning

confidence: 99%

New Understanding of Diagnosis, Treatment and Prevention of Endometriosis

Amro

Aristondo

Al-Suwaidi

et al. 2022

IJERPH

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“…Surgery may be recommended for cases that prove refractory to clinical treatment, in particular when ovarian endometriomas, endometrioma of the abdominal wall, bowel obstruction and/or ureteral obstruction are present. 152 Hysterectomy with bilateral salpingo-oophorectomy is the most effective treatment for endometriosis-associated CPP; 66 however, this procedure is the exception when all other options have failed. A Cochrane review that included 14 clinical trials and 1563 participants was unable to conclude whether laparoscopic surgery for minimal to severe endometriosis improves pain in women with CPP.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

Siqueira-Campos¹,

Deus²,

Neto³

et al. 2022

IJWH

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Chronic pelvic pain (CPP) affects a significant proportion of women worldwide And has a negative impact on several aspects of these women’s lives including mental health, work, relationships and sexual function, among others. This set of factors ultimately reflects negatively on quality Of life. The physiopathology of CPP is complex and remains to be fully clarified; however, recent advances have increased understanding of the mechanisms involved in chronic pain in general, and more specifically, CPP. Nonetheless, even when a detailed clinical history is obtained, meticulous physical examination is performed and imaging resources are appropriately used, the organic cause of the pain may still fail to be identified in a substantial number of women with CPP. Management of CPP may therefore be challenging. This narrative review was aimed at adding to the available literature on the subject, presenting and discussing the principal characteristics of CPP in women. The paper highlights gaps in the literature while providing the most up-to-date evidence associated with the physiopathology and classification of pain, its diagnosis and treatment. In addition, current challenges in the management of women with CPP are discussed.

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“…According to the genetic-epigenetic (G-E), theory endometriosis starts developing after a cumulative series of cellular incidents (54). Endometriosis lesions thus are clonal and individually different which is consistent with the variable aromatase activity and progesterone resistance (55), and the variable response to medical therapy (56,57). If lesions are different, traditional statistical analysis is inadequate (19).…”

Section: Clinical Judgment Varies With Our Perception Of Pathophysiologymentioning

confidence: 99%

Hierarchy of evidence for endometriosis diagnosis and surgery.

Koninckx

Ussia

Keckstein

et al. 2022

Preprint

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Without an animal model and a non-invasive diagnosis, the pathophysiology of endometriosis is unclear and information is limited to symptomatic women. Lesions are biochemically variable. Medical therapy cannot be blinded and extensive surgery combines low numbers with variable difficulty and surgical skills. Experience is spread among specialists in imaging, medical therapy, infertility, pain and surgery. Besides the recent changes in interpreting statistical analyses, the limited good-quality evidence increases the importance of clinical experience. Therefore trial design, analysis and judgment of results should be done by experts in the different disciplines of endometriosis, before being translated into guidelines.

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Advances in the medical management of bowel endometriosis

Cited by 25 publications

References 73 publications

New Understanding of Diagnosis, Treatment and Prevention of Endometriosis

New Understanding of Diagnosis, Treatment and Prevention of Endometriosis

Current Challenges in the Management of Chronic Pelvic Pain in Women: From Bench to Bedside

Hierarchy of evidence for endometriosis diagnosis and surgery.

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