DiVasta AD¹, Zimmerman LA², Vitonis AF³, Fadayomi AB⁴, Missmer SA⁵. Clin Gastroenterol Hepatol. 2020 Mar 14. pii: S1542-3565(20)30324-4. doi: 10.1016/j.cgh.2020.03.014. [Epub ahead of print]

Author information

1 Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA; Division of Gynecology, Department of Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: amy.divasta@childrens.harvard.edu.

2 Division of Gastroenterology, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.

3 Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

4 Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA; Department of Anesthesiology and Perioperative Medicine, University of Massachusetts Memorial Medical Center, Worcester, MA.

5 Boston Center for Endometriosis, Boston Children's Hospital and Brigham and Women's Hospital, Boston, MA; Division of Adolescent and Young Adult Medicine, Department of Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI.

Abstract

BACKGROUND: Gastroenterological (GI) symptoms are often reported by adults with endometriosis, leading to unnecessary diagnostic tests or complicated treatment. We investigated associations between endometriosis and irritable bowel syndrome (IBS) in adolescents and whether concurrent pain disorders affect these.

METHODS: We collected data within The Women's Health Study: Adolescence to Adulthood, which is a US longitudinal study of premenopausal females with and without endometriosis. Our study cohort included participants younger than 21 y enrolled from 2012-2018. Participants completed an extensive health questionnaire. Those with IBS based on self-reported diagnosis or meeting Rome IV diagnostic criteria were considered cases and those without IBS were controls. Subjects without concurrent gastrointestinal disorders or missing pain data (n=323) were included in analyses. We calculated adjusted odds ratios using unconditional logistic regression.

RESULTS: More adolescents with endometriosis (54/224; 24%) had comorbid IBS compared to adolescents without endometriosis (7/99; 7.1%). The odds of IBS was 5.26-fold higher among participants with endometriosis than without (95% CI, 2.13-13.0). In girls with severe acyclic pelvic pain, the odds of IBS was 35.7-fold higher in girls without endometriosis (95% CI, 4.67-272.6) and 12-fold higher in girls with endometriosis (95% CI, 4.2-36.3), compared to no/mild pain. For participants with endometriosis, each 1-point increase in acyclic pain severity increased the odds of IBS by 31% (adjusted odds ratio=1.31; 95% CI, 1.18-1.47).

CONCLUSIONS: In an analysis of data from a longitudinal study of girls and women with and without endometriosis, we found significant associations between endometriosis and IBS, and a linear relationship between acyclic pelvic pain severity and the odds of IBS. Increased provider awareness and screening for IBS and endometriosis will improve patient outcomes and increase our understanding of these complex disorders.