Diagnosis and management of endometriosis: a systematic review of international and national guidelines

Hirsch, Martin S.; Begum,; Paniz, Érika Vieira; Barker, Claire; Davis, CJ; Duffy, James M N

doi:10.1111/1471-0528.14838

Cited by 82 publications

(74 citation statements)

References 37 publications

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“…Nevertheless, several studies show variable and overall low levels of adherence to guidelines, particularly in obstetrics . Substantial work has gone into standardising and improving the methods used to synthesise the available scientific evidence and to develop guideline content . By contrast, the subsequent steps of guideline dissemination and implementation have received less attention and remain challenging …”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Substantial work has gone into standardising and improving the methods used to synthesise the available scientific evidence and to develop guideline content. [5][6][7] By contrast, the subsequent steps of guideline dissemination and implementation have received less attention and remain challenging. 8 The literature discusses several hypotheses intended to explain these low adherence rates.…”

Section: Introductionmentioning

confidence: 99%

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Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Rousseau

Azria

Baumann

et al. 2019

BJOG

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Objective To describe spontaneous preterm birth prevention practices self‐reported before and after the dissemination of relevant guidelines, and to identify personal and organisational factors associated with adherence. Design A repeated cross‐sectional vignette‐based survey study. Setting French obstetricians. Population French obstetricians practicing in public or private maternity units. Methods Before and after the dissemination of the 2017 French guidelines on the prevention of spontaneous preterm birth, participants were asked to complete a web‐based self‐administered questionnaire based on two clinical vignettes. Vignette 1 focused on respondents’ attitudes towards strict bed rest, cerclage, and progesterone treatment for women with a short cervix in mid‐trimester; vignette 2 focused on attitudes towards strict bed rest and maintenance tocolysis after successful tocolysis for preterm labour. A mixed quantitative and qualitative analysis was conducted. Main outcome measures Non‐adherence to guidelines for the prevention of spontaneous preterm birth in responses to each vignette. Results We obtained complete responses from 286 obstetricians before and 282 obstetricians after guideline dissemination, including 145 obstetricians participating in both. After dissemination, 51.4% of obstetricians self‐reported non‐adherent practices for vignette 1 and 22.3% of obstetricians self‐reported non‐adherent practices for vignette 2. No improvement was observed after dissemination. The quantitative analysis identified factors associated with non‐adherence, including older age and practice in non‐university or small hospitals, whereas the qualitative analysis highlighted barriers to implementation, including fear of change, habits, work overload, and lack of time. Conclusions Adherence to guidelines was generally low, with practices unmodified by their dissemination. Improvement is required, especially regarding applicability. Tweetable abstract Adherence to guidelines to prevent spontaneous preterm birth was generally low and remained unmodified after guideline dissemination.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Rousseau

Azria

Baumann

et al. 2019

BJOG

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“…Several other biomarkers, such as CA-125 and CA-19-9, have also been analysed in patients with endometriosis (6). However, no biomarkers were considered to be useful for the diagnosis of endometriosis (6,41). The usefulness of AXIN1 as a biomarker has to be further examined, independently of other biomarkers.…”

Section: Axin1 Pg/ml Hs-crp Mg/l ----------------------------------mentioning

confidence: 99%

Plasma AXIN1 expression exhibit negative correlations with inflammatory biomarkers and is associated with gastrointestinal symptoms in endometriosis

Dihm

Roth

et al. 2020

biom rep

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The cytoplasmic protein AXIN1 is involved in the Wnt signalling pathway and its expression is increased in patients with endometriosis compared with healthy controls. The aim of the present cross-sectional study was to further assess the levels of AXIN1 and other inflammatory biomarkers in patients with endometriosis. Patients with laparoscopy-verified endometriosis were recruited (n=172) and completed a questionnaire regarding socioeconomic factors, lifestyle habits and medical history. Plasma AXIN1 and high-sensitivity C-reactive protein (hs-CRP) levels were analysed by ELISA. The levels of calprotectin were determined in the faeces, and the haemoglobin concentration and number of erythrocytes, leukocytes and platelets were determined in the blood in a subgroup of 64 patients during clinical routine procedures. F-calprotectin expression was detected in 18 women (28.1%), who had more severe constipation and more frequently experienced incomplete evacuation when defecating, and 5 women (7.8%) exhibited elevated levels. P-AXIN1 levels were higher in patients who received hormonal treatment, and correlated inversely with faecal-calprotectin levels (P=0.003), B-haemoglobin levels (P=0.030) and the numbers of B-erythrocytes (P=0.033) and B-platelets (P=0.017), but were not correlated with hs-CRP levels (P=0.818). Higher levels of AXIN1 were associated with the duration of the gastrointestinal symptoms and with diarrhoea, constipation, vomiting and nausea and the intestinal symptoms' effect on quality of life, and tended to be associated with the duration of endometriosis. Hs-CRP expression was not associated with the clinical characteristics or symptoms of endometriosis, but higher levels were associated with obesity (P=0.002) and hormonal treatment (P=0.011). In conclusion, P-AXIN1 expression was negatively correlated with certain inflammatory biomarkers and was positively associated with gastrointestinal symptoms. P-AXIN1 levels were increased in patients who received hormonal treatment, highlighting the importance of obtaining native samples for future studies regarding its role in the development and presentation of endometriosis. However, hs-CRP and other studied biomarkers seemed to be of no value for the assessment and diagnosis of endometriosis.

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“…Although there is substantial variation in the recommendations and methodologic quality of the guidelines for endometriosis, many guidelines agree that this chronic condition requires long-term medical treatment despite the availability of surgical management options 1,2,[12][13][14] . The management of symptoms is the primary goal of treatment for endometriosis 1,15 .…”

Section: Introductionmentioning

confidence: 99%

Use of dienogest in endometriosis: a narrative literature review and expert commentary

Murji

Biberoğlu²,

Leng

et al. 2020

Current Medical Research and Opinion

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Objective: Endometriosis affects up to 10% of women of reproductive age, and the main goal of treatment is to relieve symptoms. Progestins have been the mainstay of endometriosis suppression, of which dienogest has become an important option in many parts of the world. This is an expert literature review, with recommendations on the use of dienogest in the context of various clinical considerations when treating endometriosis. Methods: A search of PubMed was conducted for papers published between 2007 and 2019 on the use of dienogest in endometriosis. Experts reviewed these and included those they considered most relevant in clinical practice, according to their own clinical experience. Results: Evidence regarding the long-term use (>15 months) of dienogest for the management of endometriosis is presented, with experts concluding that the efficacy of dienogest should be assessed primarily on its impact on pain and quality of life. Fertility preservation, the option to avoid or delay surgery, and managing bleeding irregularities that can occur with this treatment are also considered. Counseling women on potential bleeding risks before starting treatment may be helpful, and evidence suggests that few women discontinue treatment for this reason, with the benefits of treatment outweighing any impact of bleeding irregularities. Conclusions: Overall, the evidence demonstrates that dienogest offers an effective and tolerable alternative or adjunct to surgery and provides many advantages over combined hormonal contraceptives for the treatment of endometriosis. It is important that treatment guidelines are followed and care is tailored to the woman's individual needs and desires.

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Diagnosis and management of endometriosis: a systematic review of international and national guidelines

Cited by 82 publications

References 37 publications

Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth

Plasma AXIN1 expression exhibit negative correlations with inflammatory biomarkers and is associated with gastrointestinal symptoms in endometriosis

Use of dienogest in endometriosis: a narrative literature review and expert commentary

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