Mutual influence of clinical manifestations of intestinal disorders and intestinal microbiot indicators in patients with deep endometriosis
Authors: Braslavskaya Elena P. , Melkozerova Oksana A. , Chistyakova Guzel N. , Ustyuzhanin Alexandr V. , Mikhelson Anna A. , Avseenko Maria A. 
Published: January 2025

Summary. Endometriosis is a chronic multifactorial disease that affects more than 170 million women of reproductive age worldwide, causing pelvic pain syndrome, dyspareunia, and symptoms of gastrointestinal dyspepsia, thereby having a negative impact on the psycho-emotional state of patients. Despite a wide range of medical and surgical treatments, the relapse rate reaches 50%, which is a global economic and social problem.

The purpose of the study. to evaluate the mutual influence of clinical manifestations of intestinal disorders and the state of the intestinal microbiota in patients with deep endometriosis.

Materials and methods. The study included 83 patients of reproductive age who underwent surgical treatment of common forms of external genital endometriosis. The first group consisted of 32 patients of reproductive age who underwent repeated surgical treatment due to relapse of deep infiltrative endometriosis, the second group — 51 patients without relapse of the disease one year after the primary operation, due to deep infiltrative endometriosis, the third group — 30 patients of reproductive age. not suffering from external genital endometriosis. An analysis of the somatic anamnesis was carried out, as well as questionnaire data on pelvic pain on a visual analogue scale (VAS) and functional bowel disorders in patients with deep infiltrating endometriosis, depending on the status of relapse of the disease. The composition of the intestinal microbiota was assessed by quantitative real-time PCR using a test system for determining the DNA of intestinal-associated microorganisms.

Results and discussion. The results of the study demonstrate bidirectional relationships between clinical and microbiological parameters and the recurrent course of deep endometriosis. Patients of the main group significantly more often suffered from functional diseases of the gastrointestinal tract, the spectrum of which was represented by chronic gastritis and irritable bowel syndrome. Correlation relationships between indicators of the Bacillota domain of the intestinal microbiota and clinical and anamnestic indicators of gastrointestinal pathology, the values of questionnaire scales in patients with deep endometriosis demonstrate moderate positive relationships between the weight of patients and the number of Lachnospiraceae (r = 0.63299), symptoms of bloating and the number Streptococcus spp (r=0.67402). Correlation relationships between indicators of the Bacteroidota domain of the intestinal microbiota and corresponding indicators demonstrate strong positive relationships between the amount of E.Coli in the intestinal microbiota and the level of pain assessed on the VAS scale after 1 (r = 0.62366) and 3 months (r = 0. 72598) after surgery. Moderate positive correlations were revealed between the number of Enterobacterales in the intestinal microbiota and the level of pain assessed on the VAS scale 1 (r=0.58169) and 3 months (r=0.57706) after surgery.

Conclusions. The recurrent course of endometriosis is accompanied by functional intestinal disorders, the manifestations of which persist after surgical treatment, which is mediated by changes in the intestinal microbiota. In patients with recurrent deep endometriosis, a decrease in the species and taxonomic diversity of the intestinal microbiota was found, due to an increase in the Bacillota/Bacteroidota ratio, the number of pathobionts, and a decrease in the number of commensal bacteria of the genus Bifidobacterium spp. These clinical and microbiological parallels demonstrate the need to harmonize the intestinal microbiota as a comprehensive prevention of disease relapse.