DOP108 Inflammatory Bowel Disease and concomitant endometriosis: frequency and characteristics in a multidisciplinary approach
Authors: Fiorillo M , Neri B , Iacobini F , Mancone R , Schiavone S C , Russo C , Franchin M , Exacoustos C , Biancone L 
Published: January 2025

Abstract

Background
Inflammatory bowel disease (IBD) and endometriosis are both immuno-mediated chronic inflammatory diseases, sharing some common clinical manifestations.A possible association between IBD and endometriosis is undefined.In a multidisciplinary prospective single-center study, we aimed to assess the frequency of undiagnosed endometriosis in IBD patients (pts), by searching for symptoms compatible with this condition(dysmenorrhea, dyschezia, dyspareunia, dysuria, heavy menstrual bleeding, HMB).Secondary endpoints were to compare symptoms compatible with endometriosis in pts with vs without a diagnosis of endometriosis and search for risk factors.

Methods
All female IBD pts in childbearing age with symptoms compatible with endometriosis were enrolled.Gynecological evaluation and transvaginal ultrasonography (TVUS) was performed by our referral dedicated gynecologist to search for pelvic endometriosis.Inclusion criteria: 1)female gender; 2)age ≥18 and ≤55 years (yrs); 3)well-defined diagnosis of IBD; 4)≥1 symptom compatible with endometriosis; 5)consent.Exclusion criteria: 1)pregnancy; 2)menopause.Data expressed as median [range], difference assessed by X-square test and Mann-Whitney u-test, risk factors for endometriosis with uni and multivariate logistic regression.

Results
The study population included 70 IBD pts (age 37 [23-53] yrs), including 38(54.3%) Crohn’s Disease (CD) and 32(45.7%) Ulcerative Colitis (UC). At enrollment, questionnaires revealed dysmenorrhea in 60(85.7%), dyschezia in 22(31.4%), dyspareunia in 43(61.4%), dysuria in 4(5.7%), HMB in 43(61.4%) pts. At TVUS, endometriosis was observed in 45(64.3%) pts, adenomyosis in 26(51%). In pts showing endometriosis, deep infiltrating endometriosis (DIE) was diagnosed in 41 (91.1%) pts. Among the 45 pts with endometriosis, IBD included CD in 19(42.2%) and UC in 26(57.8%). Dysmenorrhea and dyspareunia were more frequent in pts with vs without endometriosis (42[93.3%] vs 18[72%]; p=0.03 and 32[71.1%] vs 11[44%]; p=0.04, respectively). Differently, the other considered symptoms were comparable between IBD pts with vs without endometriosis.No significant differences were observed between UC and CD pts in terms of endometriosis characteristics. At multivariate analysis, among the 5 symptoms considered, dyspareunia and HMB emerged as risk factors for endometriosis (4.4 [1.2-16.6], p=0.02; 4.1 [1.2-14.4], p=0.02, respectively).

Conclusion
Findings from a prospective multidisciplinary study suggest that endometriosis may be highly underestimated in IBD.In IBD, endometriosis was mostly represented by DIE.Among disease-specific symptoms, dyspareunia and HMB were risk factors for diagnosis of endometriosis, thus they should be carefully searched in female young IBD patients.

References
1.Neri B, Russo C, Mossa M, et al. High frequency of deep infiltrating endometriosis in patients with inflammatory bowel disease: A nested case-Control study. Digestive Dis. 2023; 41 (5): 719-728.
2.Lee KK, Jharap B, Maser EA, Colombel JF. Impact of concomitant endometriosis on phenotype and natural history of inflammatory bowel disease. Inflamm Bowel Dis 2016; 22 (1): 159-163.
3.Fiorillo, M, Neri B, Mancone R, Russo C, Iacobini F, Schiavone, SC, De Cristofaro E, Migliozzi S, Exacoustos C, Biancone L. Inflammatory Bowel Disease and Endometriosis: Diagnosis and Clinical Characteristics. Biomedicines 2024; 12: 2521