Gastrointestinal symptoms among endometriosis patients—A case-cohort study

Abstract

BackgroundWomen with endometriosis often experience gastrointestinal symptoms. Gonadotropin-releasing hormone (GnRH) analogs are used to treat endometriosis; however, some patients develop gastrointestinal dysmotility following this treatment. The aims of the present study were to investigate gastrointestinal symptoms among patients with endometriosis and to examine whether symptoms were associated with menstruation, localization of endometriosis lesions, or treatment with either opioids or GnRH analogs, and if hormonal treatment affected the symptoms.MethodsAll patients with diagnosed endometriosis at the Department of Gynecology were invited to participate in the study. Gastrointestinal symptoms were registered using the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS); socioeconomic and medical histories were compiled using a clinical data survey. Data were compared to a control group from the general population.ResultsA total of 109 patients and 65 controls were investigated. Compared to controls, patients with endometriosis experienced significantly aggravated abdominal pain (P = 0.001), constipation (P = 0.009), bloating and flatulence (P = 0.000), defecation urgency (P = 0.010), and sensation of incomplete evacuation (P = 0.050), with impaired psychological well-being (P = 0.005) and greater intestinal symptom influence on their daily lives (P = 0.001). The symptoms were not associated with menstruation or localization of endometriosis lesions, except increased nausea and vomiting (P = 0.010) in patients with bowel-associated lesions. Half of the patients were able to differentiate between abdominal pain from endometriosis and from the gastrointestinal tract. Patients using opioids experienced more severe symptoms than patients not using opioids, and patients with current or previous use of GnRH analogs had more severe abdominal pain than the other patients (P = 0.024). Initiation of either combined oral contraceptives or progesterone for endometriosis had no effect on gastrointestinal symptoms when the patients were followed prospectively.ConclusionsThe majority of endometriosis patients experience more severe gastrointestinal symptoms than controls. A poor association between symptoms and lesion localization was found, indicating existing comorbidity between endometriosis and irritable bowel syndrome (IBS). Treatment with opioids or GnRH analogs is associated with aggravated gastrointestinal symptoms.

Case–control study to develop and validate a questionnaire for the secondary prevention of endometriosis

“…The results of the bivariate analysis (firth logistic regression analysis), carried out to study the association between the outcome and each variable considered in the second part of the questionnaire, are shown in Table 2 (significant associations) and Table 3 (not significant associations). A recent Swedish study aimed to assess the gastrointestinal symptoms connected with endometriosis using the Visual Analogue Scale for Irritable Bowel (VAS-IBS) [38]. Our research assesses the gastrointestinal symptoms adopting a similar approach, and its results are in line with the most important scientific studies.…”

“…The section concerning gastrointestinal symptoms investigated non-menstrual abdominal pain, constipation, meteorism, flatulence, defecatory urgency, and feeling of incomplete defecation. This assessment was based on the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS), a validated questionnaire that aims to investigate gastrointestinal symptoms in patients not affected by organic diseases [38].…”

Gonadotropin-Releasing Hormone and Its Physiological and Pathophysiological Roles in Relation to the Structure and Function of the Gastrointestinal Tract

“…LH receptors are present in both the genital organs and the gastrointestinal tract [7,10,16,17,18], and this could be a plausible explanation for the observed association between digestive tract dysfunction and genital organ diseases in women [47,53,54,55]. The high prevalence of LH receptor polymorphism in patients who develop severe dysmotility after GnRH treatment further points to a central role of the LH receptor in gastrointestinal function [46].…”

“…The observation of increased abdominal pain in endometriosis patients in association with GnRH treatment suggests that more severe cases of endometriosis should be treated with GnRH analogs [47]. However, whether the use of analogs in this type of treatment would induce another type of abdominal pain, apart from endometriosis pain, must be further examined.…”

“…In a cohort of women with endometriosis (n = 109), patients with a history of GnRH treatment had more severe abdominal pain than patients who had never been treated with GnRH analogs [47]. Antibody development does not appear to be obligatory after GnRH treatment, but it does appear to occur more frequently in patients who develop complications in relation to the treatment [48,49].…”