Gastro-intestinal symptoms in women with pelvic endometriosis

Abstract

Gastro-intestinal symptoms frequently overlap with the clinical presentation of endometriosis. The psychological profile of patients with endometriosis may promote upper gastro-intestinal symptoms such as gastro-esophageal reflux and dyspepsia. As a consequence, neuroendocrine immune imbalance in response to high levels of perceived stress in women diagnosed with endometriosis has been demonstrated. The most common site of non-genital endometriosis is the lower intestinal tract. Lower intestinal symptoms, such as loose stools, tenesmus, constipation and abdominal pain may mimic or co-exist with those of endometriosis. The overlap of lower gastro-intestinal symptoms with those of endometriosis frequently lead to misdiagnosis or delayed diagnosis. Moreover, there appears to be an increased incidence of inflammatory bowel disease and irritable bowel syndrome in women diagnosed with endometriosis. A major portion of the intestinal tract is in close anatomical proximity to the female genital tract. Through neuroendocrine and immunological intermediaries, the upper gastro-intestinal system may also interact with the physiology of the female genital system. These variables have directed some workers to suggest an interrelationship between both systems including the occurrence of pathology. Gastro-intestinal symptoms may act as a guide to dietary modification which may result in improvement in the symptoms of endometriosis and an attenuation of its progression.