Devilish triad: Endometriosis-irritable bowel syndrome and eating disorders

Women with endometriosis report symptoms of eating disorders and irritable bowel syndrome more than the regular population

Key Points

Highlights:

• The study takes attention to the gut-brain axis and concomitant diagnosis of irritable bowel syndrome and eating disorders while managing gastrointestinal symptoms of women with endometriosis.

Importance:

• The research gives a second opinion while questioning gastrointestinal symptoms of women with endometriosis, that IBS and eating disorders should also be questioned.

What's done here:

• The researchers conducted a pilot study named ENDONUT to show the relationship between endometriosis, eating disorders, and irritable bowel syndrome.
• Patients between 18 and 50 years who were diagnosed with endometriosis in the last 4 years have been selected from the French North-West Inter-Regional Cohort of women with ENDOmetriosis by the French authority.
• Patients have been asked to fill out 5 online questionnaires: the SCOFF-F and EAT-26questionnaire for the screening of eating disorders, Rome IV and the Francis score for irritable bowel syndrome; and the HAD scale for anxiety and depression.

Key Results:

• A total of 100 patients met the inclusion criteria, 54 completed all of the surveys, and 19 had SCOFF-F scores of both endometriosis and eating disorders.
• 26 had ROME-IV scores referring coincidence of endometriosis and irritable bowel syndrome together.
• More than one-fourth of the included population showed a combination of all, and this group had significantly higher anxiety and depression scores.

Limitations:

• Patients being from a single center and the low number of responders are limitations.

Lay Summary

Most women with endometriosis report digestive symptoms. But it is not well-defined whether those are related to endometriosis itself or a secondary syndrome may be the cause. Irritable bowel syndrome, eating disorders, and anxiety are very commonly diagnosed diseases among women as well as endometriosis.

In the study conducted in France by Alexandra Aupetit et al, the relationship between these disorders has been questioned. Patients between 18 and 50 years diagnosed with endometriosis in the last 4 years have been selected from the French North-West Inter-Regional Cohort of women with ENDOmetriosis by the French authority and asked to fill 5 online questionnaires, the SCOFF-F and EAT-26 for the screening of eating disorders, Rome IV and the Francis score for the diagnosis of irritable bowel syndrome, and the HAD scale for anxiety and depression.

A total of 100 patients met the inclusion criteria, and 54 completed all the surveys. Nineteen patients had a positive SCOFF-F score meaning have both endometriosis and an eating disorder while 26 had a positive ROME-IV score referring coincidence of endometriosis and irritable bowel syndrome together. More than one-fourth of the included population showed positive eating disorder and irritable bowel syndrome scores, and this group had significantly higher anxiety and depression scores. 

The conclusion is "ENDONUT pilot study suggests an association between irritable bowel syndrome, eating disorders, endometriosis, and anxiety-depressive disorders. Further large studies should assess the common underlying mechanisms of this «four-leaf clover»," of this study which was published in the September 2022 issue of the Journal of Clinical Medicine.

Research Source: https://pubmed.ncbi.nlm.nih.gov/36233641/