Moore Judith S, Gibson Peter R, Perry Richard E, Burgell Rebecca E
Department of Gastroenterology, Central Clinical School, Monash University and Alfred Hospital, Melbourne, Victoria, Australia.
Intus, Digestive and Colorectal Care, Christchurch, New Zealand.
Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205. doi: 10.1111/ajo.12594. Epub 2017 Mar 17.
Women with endometriosis are frequently misdiagnosed with irritable bowel syndrome (IBS) for some time before a correct diagnosis is made. Visceral hypersensitivity is a key feature in both conditions.
To determine if there are distinct symptom patterns in women with IBS and endometriosis, and to determine the response of these women to a low FODMAP diet in comparison to those with IBS alone.
A retrospective analysis of prospectively collected data from women attending a specialist IBS service in Christchurch New Zealand. Data from those who met Rome III criteria for IBS were sorted into two groups: concurrent endometriosis and those with IBS alone. Demographics and symptom patterns were identified from a prospective questionnaire. A low FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) diet was taught to all women as the primary therapeutic intervention. Responses to the diet were noted against their ultimate disposition.
Of the 160 women who met Rome III criteria for IBS, 36% had concurrent endometriosis. The presence of dyspareunia (P > 0.0001), referred pain (P = 0.005), bowel symptoms exacerbated by menstruation (P = 0.0004) and a family history of endometriosis (P = 0.0003) were associated with concurrent endometriosis. Seventy two percent of these women reported a >50% improvement in bowel symptoms after four weeks of a low FODMAP diet compared with 49% in those with no known endometriosis (P = 0.001, odds ratio 3.11, 95% CI, 1.5-6.2).
Women with concurrent endometriosis and IBS report a unique symptom phenotype. The low FODMAP diet appears effective in women with gut symptoms and endometriosis.
子宫内膜异位症女性在确诊前常有一段时间被误诊为肠易激综合征（IBS）。内脏高敏感性是这两种疾病的关键特征。
确定IBS合并子宫内膜异位症女性是否存在独特的症状模式，并确定与单纯IBS女性相比，这些女性对低FODMAP饮食的反应。
对新西兰克赖斯特彻奇一家IBS专科诊所前瞻性收集的女性数据进行回顾性分析。符合罗马III标准的IBS患者数据分为两组：合并子宫内膜异位症组和单纯IBS组。通过前瞻性问卷确定人口统计学和症状模式。所有女性均接受低FODMAP（可发酵寡糖、双糖、单糖和多元醇）饮食作为主要治疗干预措施。记录饮食反应及其最终治疗转归。
在160例符合罗马III标准的IBS女性中，36%合并子宫内膜异位症。性交困难（P>0.0001）、牵涉痛（P=0.005）、月经期间肠道症状加重（P=0.0004）和子宫内膜异位症家族史（P=0.0003）与合并子宫内膜异位症相关。这些女性中有72%报告在低FODMAP饮食四周后肠道症状改善>50%，而无子宫内膜异位症者为49%（P=0.001，比值比3.11，95%CI，1.5-6.2）。
IBS合并子宫内膜异位症女性报告了独特的症状表型。低FODMAP饮食对有肠道症状的子宫内膜异位症女性似乎有效。
