Visceral hypersensitivity in endometriosis: a new target for treatment?

Issa, Basma; Onon, Toli S.; Agrawal, Anurag K.; Shekhar, Chander; Morris, Julie; Hamdy, Shaheen; Whorwell, Peter J.

doi:10.1136/gutjnl-2011-300306

Cited by 72 publications

(59 citation statements)

References 51 publications

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“…A study conducted to evaluate visceral hypersensitivity using a rectal balloon reported a lower pain threshold in women with endometriosis compared to those without the disease (Issa et al, 2012). Although there was no difference in the VAS pain score between the groups, the reduction in the pain threshold found in women with endometriosis is in agreement with reports from other studies.…”

Section: Discussionsupporting

confidence: 87%

Pain threshold and sleep quality in women with endometriosis

Nunes

Ferreira

Bahamondes

2014

European Journal of Pain

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Section: Discussionsupporting

confidence: 87%

Pain threshold and sleep quality in women with endometriosis

Nunes

Ferreira

Bahamondes

2014

European Journal of Pain

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“…Accumulating evidence supports a potential causal relationship between endometriosis and these functional pain symptoms, viscero-visceral sensitization and neurogenic inflammation might be a plausible explanation for these frequently coexisting conditions. 47,57,58 The uterus shares the same visceral innervation with the rectum and urinary bladder and a neural cross-talk among these organs is required for their physiological activities. 59,60 In fact, animal studies revealed that a subpopulation of TRPV1/TRPA1 expressing sensory neurons in the dorsal root ganglia collect nociceptive input from adjacent organs including mutual uterine-rectal, uterine-vesical and rectal-vesical neurons.…”

Section: Discussionmentioning

confidence: 99%

Local upregulation of transient receptor potential ankyrin 1 and transient receptor potential vanilloid 1 ion channels in rectosigmoid deep infiltrating endometriosis

et al. 2017

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Transient Receptor Potential Vanilloid 1 (TRPV1) and Transient Receptor Potential Ankyrin 1 (TRPA1) expressed mainly by primary sensory neurons function as major nociceptive integrators. They are also present on the rat endometrium in an oestrogen-regulated manner. TRPV1 is upregulated in peritoneal and ovarian endometriosis patients, but there is no information about TRPA1 and their pathophysiological significances. In this study, patients undergoing laparoscopic surgery were investigated: severe dysmenorrhoea due to rectosigmoid deep infiltrating endometriosis (n = 15), uterine fibroid-induced moderate dysmenorrhoea (n = 7) and tubal infertility with no pain (n = 6). TRPA1 and TRPV1 mRNA and protein expressions were determined by quantitative polymerase chain reaction and semi-quantitative immunohistochemistry from the endometrium samples taken by curettage. Results were correlated with the clinical characteristics including pain intensity. TRPA1 and TRPV1 receptors were expressed in the healthy human endometrium at mRNA and protein levels. Sparse, scattered cytoplasmic TRPA1 and TRPV1 immunopositivities were found in the stroma and epithelial layers. We detected upregulated mRNA levels in deep infiltrating endometriosis lesions, and TRPV1 gene expression was also elevated in autocontrol endometrium of deep infiltrating endometriosis patients. Histological scoring revealed significant TRPA1 and TRPV1 difference between deep infiltrating endometriosis stroma and epithelium, and in deep infiltrating endometriosis epithelium compared to control samples. Besides, we measured elevated stromal TRPV1 immunopositivity in deep infiltrating endometriosis. Stromal TRPA1 and TRPV1 immunoreactivities strongly correlated with dysmenorrhoea severity, as well TRPV1 expression on ectopic epithelial cells and macrophages with dyspareunia. Epithelial TRPA1 and stromal TRPV1 immunopositivity also positively correlated with dyschezia severity. We provide the first evidence for the presence of non-neuronal TRPA1 receptor in the healthy human endometrium and confirm the expression of TRPV1 channels. Their upregulations in rectosigmoid deep infiltrating endometriosis lesions and correlations with pain intensity suggest potential roles in pathophysiological mechanisms of the disease.

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“…In this class, immunomodulators such as interferon alpha 2 (IFN- α 2) and tumor necrosis factor (TNF) – α inhibitors have been tested in animal models [99]. In one study [100], visceral sensitivity was measured in endometriosis patients and compared with patients with irritable bowel syndrome (IBS) and identified that patients who had pain associated with endometriosis had greater visceral hypersensitivity compared to IBS patients. This not only gives a way to differentially diagnose endometriosis patients but also provides a novel target for therapy of endometriosis.…”

Section: Future Perspectivesmentioning

confidence: 99%

Endometriosis: Epidemiology, Diagnosis and Clinical Management

Parasar

Özcan

Terry

2017

Curr Obstet Gynecol Rep

518

384

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Purpose of review Endometriosis is a disease of adolescents and reproductive-aged women characterized by the presence of endometrial tissue outside the uterine cavity and commonly associated with chronic pelvic pain and infertility. Here we review the epidemiology of endometriosis as well as potential biomarkers for detection and with the goal of highlighting risk factors that could be used in combination with biomarkers to identify and treat women with endometriosis earlier.. Recent findings Early age at menarche, shorter menstrual length, and taller height are associated with a higher risk of endometriosis while parity, higher body mass index (BMI) and smoking are associated with decreased risk. Endometriosis often presents as infertility or continued pelvic pain despite treatment with analgesics and cyclic oral contraceptive pills. Summary Despite a range of symptoms, diagnosis of endometriosis is often delayed due to lack of non-invasive, definitive and consistent biomarkers for diagnosis of endometriosis. Hormone therapy and analgesics are used for treatment of symptomatic endometriosis. However, the efficacy of these treatments are limited as endometriosis often recurs. In this review, we describe potential diagnostic biomarkers and risk factors that may be used as early non-invasive in vitro tools for identification of endometriosis to minimize diagnostic delay and improve reproductive health of patients.

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Visceral hypersensitivity in endometriosis: a new target for treatment?

Cited by 72 publications

References 51 publications

Pain threshold and sleep quality in women with endometriosis

Pain threshold and sleep quality in women with endometriosis

Local upregulation of transient receptor potential ankyrin 1 and transient receptor potential vanilloid 1 ion channels in rectosigmoid deep infiltrating endometriosis

Endometriosis: Epidemiology, Diagnosis and Clinical Management

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