European Journal of Obstetrics & Gynecology and Reproductive Biology
Review articleA systematic review and meta-analysis of the associations between endometriosis and irritable bowel syndrome
Introduction
Endometriosis is a chronic condition defined by the existence of endometrial tissue outside the uterine cavity [1]. It commonly presents with dysmenorrhea, menorrhagia, chronic pelvic pain and gastrointestinal symptoms [2,3]. Like any other chronic condition, early detection is the key in the management of endometriosis, to improve prognosis and enhance the patients’ quality of life. However, prompt diagnosis of endometriosis is often delayed averaging 5–6 years, and patients often experience high disease burden related to costs of healthcare and poor physical health [4]. Before a concrete diagnosis is made, endometriosis patients receive several other diagnoses with one of the most common conditions being Irritable Bowel Syndrome (IBS) [3]. Though the two conditions are thought to have dissimilar pathophysiology, much debate exist on their close associations and common features such as low-grade inflammation, increased gut permeability and visceral hypersensitivity [[5], [6], [7], [8]]. However, management of the two conditions are different. Hence, differentiating the two conditions is paramount [7,9]. Therefore, the challenge faced by medical practitioners, whether in general, gastroenterology or gynecology practice, is to differentiate the two conditions, which is often compounded by the nature of the diagnostic procedures.
The gold standard for diagnosing endometriosis involves surgical methods, which are often saved for specific cases, due to the associated invasive nature and costs of conducting laparoscopies [10]. Thus, pelvic examination and imaging techniques are conventional to be used, in place of surgical methods, to diagnose suspected endometriosis [6]. On the other hand, there is no one standard diagnostic procedure for IBS, with the commonest guidelines used being the Manning and Rome criteria [11,12]. As a result, a firm diagnosis of IBS may vary depending on the diagnostic criteria used [13]. It is therefore no surprise, that the gastrointestinal symptoms associated with endometriosis may be diagnosed also as IBS [8,14]. This further fuels the debate on whether the two conditions coexist together, or if IBS is a misdiagnosis of symptoms related to endometriosis. To our knowledge, no systematic review and meta-analysis has been performed to evaluate the associations between endometriosis and IBS. In continuance with this debate, this paper reviewed studies conducting comparisons between endometriosis and IBS, to shed more light on the need to distinguish the two conditions and outline the magnitude of the problem.
Section snippets
Material and methods
A systematic review of the English language literature on endometriosis and IBS was carried out according to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines [15]. The search term ‘endometriosis and irritable bowel syndrome’ was used to search for published articles in MEDLINE (PubMed), Web of Science and EMBASE during June until November 2019. Articles studying a combination of endometriosis and IBS were included if: i) surgical
Publications assessed
The final search was conducted on 19th November 2019, and yielded 113 articles identified in PubMed, 234 articles in Web of Science and 357 in EMBASE. After exclusion of duplicates, reviews and conference abstracts, 254 article remained for evaluation. After exclusion of 232 articles that did not meet the inclusion criteria, 22 articles were fully assessed for eligibility. Three articles were excluded due to reliance on the patients’ self-reported diagnosis of endometriosis and IBS, while two
Discussion
To the best of the authors’ knowledge, this is the first study to systematically review articles comparing the associations between endometriosis and IBS. This systematic review and meta-analysis has found that the literature report an increased risk of endometriosis patients to also having an IBS diagnosis. This risk is inherent after a surgically confirmed endometriosis diagnosis [20]. However, the assessment of the associations between endometriosis and IBS in the available literature need
Conclusion
This review has shown the complex nature of endometriosis and IBS and the difficulty medical practitioners are faced with when diagnosing the two conditions in women. It is paramount that endometriosis is excluded in young women presenting with gastrointestinal symptoms. Given the close association of the two conditions and increased risk of being diagnosed with both, there is a need to investigate the management of endometriosis-related IBS. As a result, gastroenterologists and gynecologists
Declaration of Competing Interest
The authors have no conflicts of interest.
Acknowledgements
The study was sponsored by grants from the Development Foundation of Region Skåne. We want to thank Maria Björklund, University Library at Lund University for her skillful help with the literature search.
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TSH receptor antibodies (TRAb) – A potential new biomarker for endometriosis
2022, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :The disease affects 5–10 % of women in reproductive age causing symptoms such as pelvic pain, gastrointestinal symptoms and infertility. The entity can be difficult to differ from irritable bowel syndrome (IBS), since the gastrointestinal symptoms may be similar and both diseases are affecting young women [2]. No biomarkers are available to differ between the two diseases.
Naturopathy utilisation by Australian women with diagnosed endometriosis: A cross-sectional survey
2022, Complementary Therapies in Clinical PracticeCitation Excerpt :Within the context of gastrointestinal complaints, there is evidence that these treatments, may be effective in managing gastrointestinal complaints [29–31]. Supporting evidence has been identified that herbal medicine (including Mentha piperita, Aloe vera, and asafoetida) and dietary interventions (including elimination diets, low FODMAP diet, reducing processed foods, reducing sugar, dairy, and wheat) can provide relief in both acute and chronic experiences of bowel irregularities including diarrhoea and irritable bowel syndrome [29,31], both of which have been frequently reported among women with endometriosis [32]. Additionally, dyspareunia has also been reported by naturopathy users.