When to suspect endometriosis in IBS: tips for the gastroenterologist

Rebecca Filewood, James Tibbott, Diana Hardy
In: Frontline Gastroenterology · 2025 · pp. flgastro–2025 · doi:10.1136/flgastro-2025-103086 · W4415986234
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Gastroenterologists should consider endometriosis in patients with Irritable Bowel Syndrome due to overlapping symptoms and pathophysiological pathways, which can lead to diagnostic delays.

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Abstract

Endometriosis is a common disease affecting up to 10% of women of reproductive age. The sequelae, including pain, subfertility and impact on social well-being, result in a significant economic burden in the UK which is comparable to diabetes. Up to 90% of patients with endometriosis report symptoms that are also observed by the gastroenterologist in women who have irritable bowel syndrome. These include abdominal pain, bloating and altered bowel habit. The two conditions share a number of pathophysiological pathways and are thought to coexist in up to 60%. It is likely that the patients being treated in either clinic have an undertreated comorbidity. Patients continue to experience significant delays in the diagnosis of endometriosis and often see multiple specialities, including gastroenterology, before reaching an endometriosis specialist. While formal diagnosis requires an invasive laparoscopic procedure for biopsy, there are a number of symptoms associated with underlying endometriosis that can be used to identify patients most likely to benefit from surgery. The mainstay of treatment includes surgery or hormonal suppression. Increasing evidence continues to emerge to suggest the benefits of alternative therapies. A key alternative therapy to highlight is the positive impact on symptoms from an anti-inflammatory diet. A low fermentable oligosaccharide, disaccharide and monosaccharide and polyol diet, or exclusion of proinflammatory substances (alcohol, gluten, caffeine, dairy), has been shown to improve gastrointestinal symptoms associated with endometriosis. Raising awareness and education among healthcare professionals, and moving towards multidisciplinary team working aims to reduce time to diagnosis and improve patient outcomes.
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Article Text Abstract Endometriosis is a common disease affecting up to 10% of women of reproductive age. The sequelae, including pain, subfertility and impact on social well-being, result in a significant economic burden in the UK which is comparable to diabetes. Up to 90% of patients with endometriosis report symptoms that are also observed by the gastroenterologist in women who have irritable bowel syndrome. These include abdominal pain, bloating and altered bowel habit. The two conditions share a number of pathophysiological pathways and are thought to coexist in up to 60%. It is likely that the patients being treated in either clinic have an undertreated comorbidity. Patients continue to experience significant delays in the diagnosis of endometriosis and often see multiple specialities, including gastroenterology, before reaching an endometriosis specialist. While formal diagnosis requires an invasive laparoscopic procedure for biopsy, there are a number of symptoms associated with underlying endometriosis that can be used to identify patients most likely to benefit from surgery. The mainstay of treatment includes surgery or hormonal suppression. Increasing evidence continues to emerge to suggest the benefits of alternative therapies. A key alternative therapy to highlight is the positive impact on symptoms from an anti-inflammatory diet. A low fermentable oligosaccharide, disaccharide and monosaccharide and polyol diet, or exclusion of proinflammatory substances (alcohol, gluten, caffeine, dairy), has been shown to improve gastrointestinal symptoms associated with endometriosis. Raising awareness and education among healthcare professionals, and moving towards multidisciplinary team working aims to reduce time to diagnosis and improve patient outcomes. - ABDOMINAL PAIN - IRRITABLE BOWEL SYNDROME Statistics from Altmetric.com Footnotes Contributors RF: literature search, first and final draft, revised flowchart, visual abstract. DH: senior author, final draft review, draft flowchart, concept, final draft (guarantor). JT: contributing to writing and drafts. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests I declare that RF, JT and DH have no competing conflict of interest in this article. Provenance and peer review Not commissioned; externally peer reviewed. Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Condition tags

endometriosisirritable_bowel_syndrome

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