Auswahl der wissenschaftlichen Literatur zum Thema „Digestive endometriosis“

The study of neurohormonal-visceral relationships in patients with uterine endometriosis is of practical significance in the development of rational therapy and prevention of this complex and rather frequent pathology. This study was aimed to investigate the functional state of the digestive glands of the stomach, intestines, liver and pancreas in 152 patients with uterine internal endometriosis (Group 1) and in 50 patients with recurrent endometrial hyperplasia (Group 2). Twenty healthy women were the control group. Patients with no history of diseases of the digestive system were selected for the examination.

Background and aim: Irritable bowel syndrome (IBS), eating disorders (ED) and endometriosis share common pathophysiological mechanisms, involving alterations of the gut–brain axis. The aim of the ENDONUT pilot study was to investigate an association between these three diseases by screening for IBS and ED in patients with endometriosis. Method: We included patients from the CIRENDO cohort (Inter-Regional North-West Cohort of women with ENDOmetriosis) with a recent documented diagnosis of endometriosis of less than 4 years, regardless of age, date of onset of symptoms, type of endometriosis (digestive or not), with or without endometriosis-related digestive surgery. Validated questionnaires were used to screen for IBS (Rome IV, Francis score), ED (SCOFF-F, EAT-26), and anxiety/depression (HAD). Anthropometric data and lifestyle habits were also collected. The primary composite endpoint was SCOFF-F and ROME-IV scores. Results: Among 100 patients meeting inclusion criteria, 54 patients completed all the questionnaires. Of these, 19 had a positive SCOFF-F score (35.2%), 26 had a positive ROME-IV score (48.1%), and 14 patients (25.9%) had both a positive SCOFF-F score and a positive ROME-IV score (p = 0.006). Patients with positive SCOFF-F and ROME-IV scores had significantly higher HAD-anxiety and depression scores (p < 0.05). Conclusion: These results suggest a significant association between IBS, ED and endometriosis. The prevalence of IBS and ED in our population is higher than in the general population. Larger studies are needed to confirm these results, to better understand this triad, and to improve the diagnostic and multidisciplinary therapeutic management of these patients.

Introduction and aim. Endometriosis is a complex condition in which endometrium, tissue that resembles the uterine lining, develops outside the uterus. It is considered to be a chronic, estrogen-dependent, inflammatory gynecological disorder having multi-factorial origins. This review paper aims to consolidate recent information on ethnic differences, endometriosis risks, and the disease’s etiology in the global context. Material and methods. A systematic search was performed using a variety of international electronic databases, including “PubMed” and “DOAJ”, using the terms endometriosis, endometriosis and infertility, endometriosis and cancer, and treatment of endometriosis. Analysis of the literature. Endometriosis can appear anywhere in the body, including the umbilicus, the cecum and ileum of the digestive tract, the breast, the lungs, and the genitourinary organs. It is typically clinically asymptomatic with no obvious clinical manifestation and expensive treatment, which makes the diagnosis late. There is a complex interplay between socioeconomic status, family history, societal beliefs and laws, personal habits, reproductive and gynaecological conditions, and environmental influences in the development of endometriosis. Conclusion. Women with endometriosis should be given more attention, and specific resources in the healthcare system should be utilized to provide more efficient multidisciplinary healthcare and treatment.

Rationale: Endometriosis, a benign disease, has a malignant biological behavior and is highly prone to recurrence. Although gastrointestinal involvement is the most common site for extra-genital endometriosis, deep infiltrative endometriosis, which affects the mucosal layer, is very rare. Patient concerns: A 44-year-old woman with a 6-month history of recurring abdominal pain and Hematochezia. The patient visited several hospitals over the past six months and was suspected to have been diagnosed with a digestive disease, for which medication was ineffective, leading to a great deal of anxiety. Diagnoses: Colonic endometriosis. Interventions: After a thorough imaging evaluation and preoperative discussion, laparoscopic colonic endometriosis resection under indocyanine green indication was performed by gynecologists and gastroenterologists. Outcomes: After laparoscopic treatment, the patient's symptoms improved significantly, with occasional pain felt and no blood in the stool. Lessons: This case provides a rare example of sigmoid endometriosis causing periodic abdominal pain and Hematochezia. We report a clinical case to investigate the feasibility of an indocyanine green fluorescent contrast technique to guide the scope of surgery in laparoscopic deep infiltrative endometriosis surgery. In intestinal endometriosis surgery, indocyanine green fluoroscopy may indicate the lesion's precise localization.

CONTEXT AND OBJECTIVE: Endometriosis is a common affliction that may affect the intestinal tract. The objective of this case report was to describe an unusual clinical presentation of this form of the disease. CASE REPORT: The patient was a 35-year-old woman with epigastric pain that only occurred during menstruation, who had a history of bladder endometriosis. Endoscopy of the upper digestive tract showed normal results. Transvaginal ultrasound and nuclear magnetic resonance of the pelvis showed a lesion involving the ileocecal junction and appendix, measuring 30 x 22/x/13/mm, that was suggestive of endometriosis. The patient underwent laparoscopic resection of the bowel segment affected by the disease, followed by anastomosis of the ileum and ascending colon for immediate restoration of intestinal transit. Histological analysis confirmed the diagnosis of endometriosis. CONCLUSIONS: In young women, recurrent epigastric pain should be evaluated with regard to its relationship to menstruation, particularly if there is a history of endometriosis, since this may be a clinical sign that the disease is affecting the intestinal transit.

In the last years, a potential link between endometriosis and celiac disease has been hypothesized since these disorders share some similarities, specifically concerning a potential role of oxidative stress, inflammation, and immunological dysfunctions. We investigated the prevalence of celiac disease among Italian women with endometriosis with respect to general population. Consecutive women with a laparoscopic and histological confirmed diagnosis of endometriosis were enrolled; female nurses of our institution, without a known history of endometriosis, were enrolled as controls. IgA endomysial and tissue transglutaminase antibodies measurement and serum total IgA dosage were performed in both groups. An upper digestive endoscopy with an intestinal biopsy was performed in case of antibodies positivity. Presence of infertility, miscarriage, coexistence of other autoimmune diseases, and family history of autoimmune diseases was also investigated in all subjects. Celiac disease was diagnosed in 5 of 223 women with endometriosis and in 2 of 246 controls (2.2% versus 0.8%;P=0.265). Patients with endometriosis showed a largely higher rate of infertility compared to control group (27.4% versus 2.4%;P<0.001). Our results confirm that also in Italian population an increased prevalence of celiac disease among patients with endometriosis is found, although this trend does not reach the statistical significance.

OBJECTIFS : Dans cette thèse nous avons décrit une nouvelle technique de prise en charge de l'endométriose profonde postérieure recto-sigmoïdienne par ultrasons focalisés de haute intensité échoguidés par voie transrectale (TR-USgHIFU), avant de rechercher les facteurs limitants de cette technique ainsi que les moyens d’améliorer sa faisabilité et son efficacité. METHODES : Nous avons tout d’abord conduit une étude clinique de phase I pour tester la faisabilité du traitement par TR-USgHIFU à l’aide de la sonde FocalOne®. Nous avons ensuite réalisé une étude sur pièces anatomiques visant à rechercher les facteurs limitants l’utilisation de la sonde FocaleOne® et à tester un autre prototype de sonde HIFU comme alternative à cette dernière. Nous avons également réalisé une étude clinique observationnelle pour mesurer l’atténuation acoustique des lésions d’endométriose recto-sigmoïdienne et de l’intestin normal. Nous avons enfin mis au point un modèle murin d’endométriose sous-cutané pour évaluer les effets anatomo-pathologiques des HIFU sur l’endométriose. RESULTATS : Nous avons inclus 23 patientes dans l’étude clinique de phase I entre juin 2015 et octobre 2019 dont 20 ont pu être traitées (faisabilité de 87%). Aucun effet indésirable grave n’a été rapporté. Nous n’avons pas observé pas de modification significative du volume des lésions à 6 mois, mais nous rapportons une amélioration significative des symptômes douloureux digestifs et gynécologiques ainsi qu’une amélioration de la qualité de vie des patientes. Les analyses sur pièces anatomiques et sur IRM démontrent le rôle du sacrum et de la charnière recto-sigmoïdienne dans les limitations mécaniques de la sonde FocalOne®. L’utilisation d’une sonde moins encombrante avec une focale plus courte semble être bénéfique pour augmenter la faisabilité du traitement. Notre étude sur 13 patientes traitées chirurgicalement d’un nodule du rectum ou du sigmoïde, a montré que l’atténuation à 3 MHz de l’endométriose digestive est de 50,2 Np/m. Cette valeur est significativement plus élevée que celle de l’intestin sain (32,8 ; p<0,001). Nous avons enfin montré que le modèle murin hétérologue sous-cutané « BALB/c-nude#Ishikawa » est fiable et performant pour l’étude des effets des HIFU sur l’endométriose profonde digestive, en raison notamment d’une atténuation acoustique remarquablement proche de celle de l’endométriose recto-sigmoïdienne. Grâce à ce modèle nous avons démontré que le traitement HIFU provoquait une nécrose de type « ischémique » au niveau de la cible. CONCLUSION : Le traitement par TR-USgHIFU dans l’endométriose recto-sigmoïdienne est faisable et sûr. Son efficacité morphologique reste à démontrer mais son efficacité clinique significative est prometteuse. Il pourrait s’agir d’une alternative minimalement invasive de choix pour remplacer le traitement chirurgical dans cette indication, en particulier pour les lésions les plus basses situées
OBJECTIVES: In this thesis we describe a new technique for the management of rectosigmoid endometriosis by transrectal ultrasound-guided high intensity focused ultrasound ultrasound (TR-USgHIFU). We also review several limiting factors of this technique before assessing several modifications to improve the feasibility and the efficacy of the procedure. METHODS: We first conducted a phase I clinical trial to test the feasibility of TR-USgHIFU treatment using the FocalOne® device. We then carried out a study on anatomical specimens to assess the limiting factors of the FocaleOne® probe and to test another HIFU probe, which has smaller transducer and which is mounted on a flexible endoscope. We also performed an observational clinical study to measure the acoustic attenuation of rectosigmoid endometriosis lesions and that of normal bowel. Finally, we have developed a murine model of subcutaneous endometriosis to assess the pathophysiological effects of HIFU on endometriosis. RESULTS: We included 23 patients in the phase I clinical trial between June 2015 and October 2019. Treatment was carried out in 20 of these patients (87% feasibility). No serious adverse events have been reported. We did not find a significant morphological effect at 6 months, but we report a significant improvement on digestive and gynecological symptoms as well as on patients’ quality of life. Studies on anatomical specimens and on MRI pictures demonstrated the role of the sacrum and the recto-sigmoid hinge in the mechanical limitations of the FocalOne® probe. The use of a smaller probe with a shorter focal could be interesting in order to increase the feasibility of the treatment. Our study on 13 patients treated surgically for rectum or sigmoid endometriosis nodule, showed that attenuation of digestive endometriosis at 3 MHz is 50.2 Np / m. This value was significantly higher than attenuation of the normal bowel (32.8; p <0.001). We finally showed that the heterologous subcutaneous murine model "BALB / c-nude # Ishikawa" was reliable and efficient to study the effects of HIFU on digestive endometriosis, as the acoustic attenuation of its nodules are remarkably close to that of endometriosis lesions. Thanks to this model, we reported that HIFU lesions are associated with a higher rate of ischemic and coagulation necrosis. CONCLUSIONS: Treatment with TR-USgHIFU in rectosigmoid endometriosis is feasible and safe. Its morphological efficacy remains to be demonstrated, but its significant clinical efficacy is promising. It could become be a minimally invasive alternative to replace surgical treatment in this indication, especially for rectal lesions

This chapter presents some examples of modern research on acupuncture. They include studies on the physiological nature of acupuncture points and of acupuncture’s impact on the functions of the immune, endocrine, nerve, cardiovascular, digestive, respiratory, and reproductive systems. It also includes examples of clinical studies on the safety and efficacy of acupuncture on various clinical medical and psychiatric conditions such as asthma, infertility, gastroesophageal reflux disorder (GERD), endometriosis, chronic pain, depression, anxiety, and insomnia. It discusses the confusion in research conclusions caused by methodological deficits in study designs and interventions, and it initiates a discussion on the future direction of studies that benefit advances in modern medicine rather than judging acupuncture using pharmaceutical models of research that are unable to visualize and measure human energy.