Gastrointestinal symptoms among endometriosis patients-A case-cohort study
Gastrointestinal symptoms among endometriosis patients-A case-cohort study
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DOI：
10.1186/s12905-015-0213-2
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发表时间：
2015-08-13
影响因子：
2.5
通讯作者：
Ohlsson, Bodil
中科院分区：
文献类型：
--
作者：
Ek, Malin;Roth, Bodil;Ohlsson, Bodil
背景：患有子宫内膜异位症的女性经常会出现胃肠道症状。促性腺激素释放激素（GnRH）类似物用于治疗子宫内膜异位症；然而，一些患者在接受这种治疗后出现胃肠动力障碍。本研究的目的是调查子宫内膜异位症患者的胃肠道症状，并检查症状是否与月经、子宫内膜异位病灶的定位、阿片类药物或 GnRH 类似物的治疗有关，以及激素治疗是否影响症状。 方法：邀请所有在妇科诊断为子宫内膜异位症的患者参加该研究。使用肠易激综合症视觉模拟量表（VAS-IBS）记录胃肠道症状；社会经济史和医学史是通过临床数据调查编制的。将数据与一般人群的对照组进行比较。结果：总共调查了 109 名患者和 65 名对照者。与对照组相比，子宫内膜异位症患者的腹痛（P = 0.001）、便秘（P = 0.009）、腹胀和胀气（P = 0.000）、排便急迫（P = 0.010）和排便不完全的感觉（P = 0.050）明显加重，心理健康受损（P = 0.005），肠道症状对其影响更大。日常生活（P = 0.001）。除了肠道相关病变患者恶心和呕吐增加（P=0.010）外，这些症状与月经或子宫内膜异位症病变定位无关。一半的患者能够区分子宫内膜异位症和胃肠道引起的腹痛。使用阿片类药物的患者比不使用阿片类药物的患者经历更严重的症状，并且当前或既往使用 GnRH 类似物的患者比其他患者有更严重的腹痛 (P = 0.024)。当对患者进行前瞻性随访时，开始使用复方口服避孕药或黄体酮治疗子宫内膜异位症对胃肠道症状没有影响。结论：大多数子宫内膜异位症患者的胃肠道症状比对照组更严重。研究发现症状和病变定位之间的关联性较差，表明子宫内膜异位症和肠易激综合征（IBS）之间存在共病。阿片类药物或 GnRH 类似物治疗会导致胃肠道症状加重。
Background: Women with endometriosis often experience gastrointestinal symptoms. Gonadotropin-releasing hormone (GnRH) analogs are used to treat endometriosis; however, some patients develop gastrointestinal dysmotility following this treatment. The aims of the present study were to investigate gastrointestinal symptoms among patients with endometriosis and to examine whether symptoms were associated with menstruation, localization of endometriosis lesions, or treatment with either opioids or GnRH analogs, and if hormonal treatment affected the symptoms.Methods: All patients with diagnosed endometriosis at the Department of Gynecology were invited to participate in the study. Gastrointestinal symptoms were registered using the Visual Analogue Scale for Irritable Bowel Syndrome (VAS-IBS); socioeconomic and medical histories were compiled using a clinical data survey. Data were compared to a control group from the general population.Results: A total of 109 patients and 65 controls were investigated. Compared to controls, patients with endometriosis experienced significantly aggravated abdominal pain (P = 0.001), constipation (P = 0.009), bloating and flatulence (P = 0.000), defecation urgency (P = 0.010), and sensation of incomplete evacuation (P = 0.050), with impaired psychological well-being (P = 0.005) and greater intestinal symptom influence on their daily lives (P = 0.001). The symptoms were not associated with menstruation or localization of endometriosis lesions, except increased nausea and vomiting (P = 0.010) in patients with bowel-associated lesions. Half of the patients were able to differentiate between abdominal pain from endometriosis and from the gastrointestinal tract. Patients using opioids experienced more severe symptoms than patients not using opioids, and patients with current or previous use of GnRH analogs had more severe abdominal pain than the other patients (P = 0.024). Initiation of either combined oral contraceptives or progesterone for endometriosis had no effect on gastrointestinal symptoms when the patients were followed prospectively.Conclusions: The majority of endometriosis patients experience more severe gastrointestinal symptoms than controls. A poor association between symptoms and lesion localization was found, indicating existing comorbidity between endometriosis and irritable bowel syndrome (IBS). Treatment with opioids or GnRH analogs is associated with aggravated gastrointestinal symptoms.