High Frequency of Deep Infiltrating Endometriosis in Patients with Inflammatory Bowel Disease: A Nested Case-Control Study

Abstract

<b><i>Introduction:</i></b> Inflammatory bowel disease (IBD) and endometriosis are chronic inflammatory diseases occurring in young women, sharing some clinical manifestations. In a multidisciplinary approach, we aimed to investigate symptoms, type, and site of pelvic endometriosis in IBD patients versus non-IBD controls with endometriosis. <b><i>Methods:</i></b> In a prospective nested case-control study, all female premenopausal IBD patients showing symptoms compatible with endometriosis were enrolled. Patients were referred to dedicated gynecologists for assessing pelvic endometriosis by transvaginal sonography (TVS). Each IBD patient with endometriosis (cases) was retrospectively matched for age (±5 years) and body mass index (±1) with 4 patients with endometriosis at TVS but no-IBD (controls). Data were expressed as median [range]; the Mann-Whitney or Student <i>t</i> and χ<sup>2</sup> tests were used for comparisons. <b><i>Results:</i></b> Endometriosis was diagnosed in 25 (71%) out of 35 IBD patients with compatible symptoms including 12 (52.6%) Crohn’s disease and 13 (47.4%) ulcerative colitis patients. Dyspareunia and dyschezia were significantly more frequent in cases versus controls (25 [73.7%] vs. 26 [45.6%]; <i>p</i> = 0.03). At TVS, deep infiltrating endometriosis (DIE) and posterior adenomyosis were significantly more frequently observed in cases versus controls (25 [100%] vs. 80 [80%]; <i>p</i> = 0.03 and 19 [76%] vs. 48 [48%]; <i>p</i> = 0.02). <b><i>Conclusions:</i></b> Endometriosis was detected in two-thirds of IBD patients with compatible symptoms. The frequency of DIE and posterior adenomyosis was higher in IBD than in controls. A diagnosis of endometriosis, often mimicking IBD activity, should be considered in subgroups of female patients with IBD.

Potential shared pathogenic mechanisms between endometriosis and inflammatory bowel disease indicate a strong initial effect of immune factors

“…The increased risk of IBD in patients with EM was also confirmed by Lee et al. ( 17 , 18 ). A Mendelian randomization study in 2023 found that EM is a risk factor for the development of IBD, especially in people with advanced EM ( 19 ).…”

Case report: A rare cause of intestinal perforation in a third-trimester pregnant woman

“…If the ileum is the main area of manifestation, the resulting symptoms can imitate an active Crohn’s disease and therefore complicate the diagnostic procedures ( 13 , 14 ). In addition, deep infiltrating endometriosis is significantly more common in patients with chronic inflammatory bowel diseases (CIBDs) ( 15 ). However, in case of sudden onset of pain in the right lower abdomen in combination with local muscular guarding and positive clinical signs typical of appendicitis, e.g., the psoas sign or Rovsing’s sign, endometriosis may deceptively mimic acute appendicitis, as presented in our case report ( 12 ).…”

Deep Infiltrating Endometriosis in Adolescence: Early Diagnosis and Possible Prevention of Disease Progression

“…Endometriosis can mimic the clinical features of several organic pathologies, including inflammatory bowel diseases, irritable bowel syndrome, Meckel's diverticulum, celiac disease and sub-acute/chronic appendicitis [94][95][96][97], imposing a multidisciplinary approach to exclude gastrointestinal diseases. Noteworthy, these autoimmune-based inflammatory pathologies can often be associated with endometriosis [98].…”