{"paper_id":"d6b601b0-a9fc-4903-aa1d-bb96b4506deb","body_text":"Abstract\nObjective\nEndometriosis (EMT) and irritable bowel syndrome (IBS) disproportionately affect middle-aged and older women, where overlapping symptoms (e.g., chronic pelvic pain, bloating) and shared inflammatory mechanisms may drive comorbidity. However, large-scale evidence linking EMT to IBS incidence in this population remains scarce. Leveraging the UK Biobank cohort (N = 225,703), we investigate their longitudinal association to address this critical gap in women's health research.\nMethod\nWe sourced data on pre-existing endometriosis (EMT) status and incident IBS diagnoses from the UK Biobank. We employed multivariate Cox regression to analyze the link between baseline EMT and subsequent IBS, as well as the association with different IBS subtypes and severities. Subgroup and sensitivity analyses were also performed.\nResult\nThe study population comprised 225,703 individuals, with 6379 cases (2.83%) exhibiting EMT at initial assessment and 6282 cases (2.78%) developing IBS during a median observation period of 13.8 years (IQR 13–14.5). EMT patients showed significantly elevated cumulative incidence of hypertension compared to population controls (4.61%, p < 0.001). Adjusted Cox models identified EMT as an independent predictor of IBS development (hazard ratio 1.58, 95% CI 1.38–1.82; p < 0.001). Subtype analysis revealed specific risk elevation for constipation-predominant (IBS-C) and mixed-pattern (IBS-M) variants (both p < 0.001), though no significant associations emerged for diarrhea-predominant subtypes(IBS-D). These findings persisted across sensitivity analyses and subgroup evaluations, confirming EMT's robust association with incident IBS.\nConclusion\nClinical data analysis revealed elevated IBS susceptibility among EMT-affected individuals relative to reference populations, with notable predisposition toward IBS-C. These findings suggest clinical relevance of EMT-IBS correlations, requiring integration of EMT status into diagnostic evaluations for gastrointestinal symptom management.\nSimilar content being viewed by others\nData Availability\nOriginal data may be obtained from a third party and are not publicly available. The UK Biobank data are available on application at https://www.ukbiobank.ac.uk. The analysis data is provided in the manuscript or supplementary information file.\nAbbreviations\n- IBS:\n-\nIrritable bowel syndrome\n- EMT:\n-\nEndometriosis\n- IBD:\n-\nInflammatory bowel disease\n- EstBB:\n-\nEstonian biobank EstBB\n- UKB:\n-\nUK Biobank\n- ICD-10:\n-\nInternational classification of diseases-10\n- IBS-SSS:\n-\nIBS symptom severity scale\n- CI:\n-\nConfidence interval\n- TDI:\n-\nTownsend deprivation index\n- BMIL:\n-\nBody mass index\n- EMT:\n-\nEndometriosis\n- IPAQ:\n-\nInternational physical activity questionnaire\n- EH:\n-\nEssential hypertension\nReferences\nFord AC, Sperber AD, Corsetti M, Camilleri M. Irritable bowel syndrome. Lancet 2020;396:1675–1688.\nKhan A, Menon R, Corning B, Cohn S, Kumfa C, Raji M. Mirtazapine for gastrointestinal and neuropsychological symptoms in older adults with irritable bowel syndrome. 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Cabrera Carranco, 2024 Endometriosis: A Comprehensive Analysis of the Pathophysiology, Treatment, and Nutritional Aspects, and Its Repercussions on the Quality of Life of Patients, Biomedicines, 12\nOszajca K, Adamus A. Diet in Prevention and Treatment of Endometriosis: Current State of Knowledge. Curr Nutr Rep 2024;13:49–58.\nFunding\nThis work was supported by the National Natural Science Foundation of China [grant numbers:81770540]; Key Research and Development Projects of Shaanxi Province [grant numbers: S2023-YF-YBSF-1670].\nAuthor information\nAuthors and Affiliations\nContributions\nFormal analysis: Lianli Wang and Yan Ran. Funding acquisition: Fei Dai. Investigation: Lin Mei and Yating Sun. Methodology: Lianli Wang and Yan Ran. Resources: Fei Dai. Visualization: Lianli Wang, Yan Ran and Xinping Zhang. Writing–original draft: Fangchen Ye, Laifu Li and Fangyi Ruan. Writing–review and editing: Fei Dai.\nCorresponding author\nEthics declarations\nConflict of interest\nThe authors declare no competing interests.\nEthical approval\nUK Biobank data has approval from the North West Multi-centre Research Ethics Committee (MREC) (REC reference: 21/NW/0157). All subjects providing signed consent forms. For more detailed information, please refer to https://www.ukbiobank.ac.uk. Clinical trial number: not applicable.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nSupplementary Information\nBelow is the link to the electronic supplementary material.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nYe, F., Li, L., Ruan, F. et al. A Previous History of Endometriosis Elevates Irritable Bowel Syndrome Risk in Middle-Aged and Older Women: A UK Biobank Cohort Study of 225,703 Participants. Dig Dis Sci (2026). https://doi.org/10.1007/s10620-026-09711-1\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s10620-026-09711-1","source_license":"public-domain-us","license_restricted":false}