Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses

Abstract

ObjectiveTo estimate the pooled odds ratio of endometriosis and irritable bowel syndrome, and to estimate the pooled prevalence of irritable bowel syndrome in patients with endometriosis.Data sourcesUsing Cochrane Library, MEDLINE, Science Direct, ClinicalTrials.gov, Web of Science, and CINAHL, we conducted a systematic literature search through October 2021, using the key terms “endometriosis” and “irritable bowel syndrome.” Articles had to be published in English or Spanish. No restriction on geographical location was applied.Methods of study selectionThe following eligibility criteria were applied: full-text original articles; human studies; studies that investigated the association between endometriosis and irritable bowel syndrome. Two investigators screened and reviewed the studies. A total of 1,776 studies were identified in 6 separate databases. After screening and applying the eligibility criteria, a total of 17 studies were included for analyses. The meta-analysis of association between endometriosis and irritable bowel syndrome included 11 studies, and the meta-analysis on the prevalence of irritable bowel syndrome in endometriosis included 6 studies.Tabulation, integration, and resultsOverall 96,119 subjects were included in the main meta-analysis (11 studies) for endometriosis and irritable bowel syndrome, with 18,887 endometriosis patients and 77,171 controls. The odds of irritable bowel syndrome were approximately 3 times higher among patients with endometriosis compared with healthy controls (odds ratio 2.97; 95% confidence interval, 2.17 – 4.06). Similar results were obtained after subgroup analyses by endometriosis diagnosis, irritable bowel syndrome diagnostic criteria, and Newcastle-Ottawa Scale scores. Six studies reported prevalence rates of irritable bowel syndrome in women with endometriosis, ranging from 10.6 to 52%. The pooled prevalence of irritable bowel syndrome in women with endometriosis was 23.4% (95% confidence interval, 9.7 – 37.2).ConclusionPatients with endometriosis have an approximately threefold increased risk of developing irritable bowel syndrome. Development and recent update of Rome criteria has evolved the diagnosis of IBS, potential bias should still be considered as there are no specific tests available for diagnosis.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/displa y_record.php?ID=CRD42018080611], identifier [CRD42018080611].

Nutritional practices and dietetic provision in the endometriosis population, with a focus on functional gut symptoms

“…In our sample, 38.5% ( n = 533) of respondents reported to have been diagnosed with IBS, with most (80%, n = 427) having been diagnosed prior to endometriosis. These values are slightly higher than those reported in the three aforementioned systematic reviews 11,12,30 ; however, our sample may have been biased because those with gut symptoms were more likely to participate and diagnoses of both conditions were self‐reported. Nevertheless, although global symptom relief, pain when opening bowels and stool type were all significantly worse in respondents with IBS, more than half of IWE without IBS also had abnormal findings for these parameters.…”

“…10 The association between the two conditions has been investigated by three recent systematic reviews, all of which found evidence of two-to three-fold risk of IBS in IWE compared to those without endometriosis. 11,12,30 Nabi et al 30 who analysed 17 studies (n = 96,974), reported a pooled prevalence of IBS in women with endometriosis of 23.4%. Saidi et al 12 identified a gap in adjusting for factors that may have affected gastrointestinal symptoms (e.g., phases of the menstrual cycle and psychological aspects).…”

“…As a result of the diagnosis of endometriosis requiring invasive laparoscopic surgery, patients often receive multiple etiologies and diagnoses for their symptoms, with IBS being the most common 10 . The association between the two conditions has been investigated by three recent systematic reviews, all of which found evidence of two‐ to three‐fold risk of IBS in IWE compared to those without endometriosis 11,12,30 . Nabi et al 30 who analysed 17 studies ( n = 96,974), reported a pooled prevalence of IBS in women with endometriosis of 23.4%.…”

The association between dietary inflammatory index with endometriosis: NHANES 2001–2006

“…Importantly, this relationship remained significant after adjusting for other exposure covariates in the multivariate regression analysis. As a common gynecological disorder with high prevalence, EM seriously affects people of childbearing age [18]. While inflammation is a key physiological and pathological feature of EM, the altered inflammatory microenvironment in endometriotic tissue may lead to the persistence of chronic pain [19,20].…”

UPLC-Q-TOF/MS Based Plasma Metabolomics for Identification of Paeonol’s Metabolic Target in Endometriosis

“…Conventional therapies include danazol, progesterone, NSAIDs, etc. [ 8 , 9 , 10 , 11 ]. The drugs mentioned aim to lower estrogen levels, raise progesterone levels, or suppress inflammation [ 12 ].…”