Love Thy Neighbor? Exploring Gastroenterology Attitudes Towards Endometriosis Screening

Love Thy Neighbor? 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Exploring Gastroenterology Attitudes Towards Endometriosis Screening Yuying Luo, Xiao Jing Wang, Laurie A. Keefer, Madison Simons This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5088830/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Nov, 2024 Read the published version in Digestive Diseases and Sciences → Version 1 posted 7 You are reading this latest preprint version Abstract Endometriosis is a chronic painful condition affecting 10% of reproductive-aged women with a high prevalence of overlapping gastrointestinal symptoms. There is a significant diagnostic delay for endometriosis and current screening practices for endometriosis in gastroenterology clinic populations have not been evaluated. 112 gastroenterology providers (57.5% females, 64.3% physicians) completed an anonymized exploratory survey (40.1% response rate). Most respondents (59.4%) currently do not screen for endometriosis, but the majority (72.1%) reported they would be “extremely likely” or “somewhat likely” to screen for endometriosis after being presented with data on the high prevalence of chronic GI symptoms in patients with endometriosis. endometriosis women’s digestive health Figures Figure 1 Full Text Endometriosis is a chronic painful condition affecting about 10% of reproductive-aged women [1]. Up to 90% of women with endometriosis (independent of the location) have concomitant irritable bowel syndrome-like (IBS) symptoms including chronic abdominal pain, bloating, and altered bowel movements [2,3]. The overlap with gastrointestinal (GI) symptoms is thought to be multifactorial with potential etiologies including visceral organ cross-talk, chronic low-grade inflammation, and dysbiosis [4] with newer research demonstrating evidence of shared risk loci in patients with endometriosis and GI conditions such as IBS [5]. Unfortunately, patients experience a diagnostic delay of between 4-11 years from symptom onset with a debilitating impact on health-related quality of life in addition to complications such as infertility and ovarian cancer [6,7,8]. This has led to a recent paradigm shift proposed by gynecologic societies to move away from the traditional reliance on a surgical diagnosis of endometriosis to one which focuses on patient symptoms (persistent and/or worsening cyclic or constant pelvic pain, dysmenorrhea, deep dyspareunia, cyclic dyschezia, dysuria or catamenial symptoms in other systems) and/or imaging (e.g. MRI and ultrasounds) [9]. Gastroenterologists have a potentially important role in reducing this diagnostic delay; in one study, more than 20% of patients with endometriosis presented for GI evaluation prior to a surgical diagnosis [10]. Current screening practices for endometriosis in GI clinic populations have not been evaluated and may impact the feasibility of future initiatives in this arena. Our aim was to explore the state of current screening practices and attitudes towards screening for endometriosis by gastroenterology providers with the goal of informing future feasibility and clinical studies. An anonymized exploratory survey was sent to a total of 294 providers (physicians, gastropsychologists, advanced practitioners) at three academic centers and two private practices caring for adult GI patients with geographic diversity. IRB approval was obtained from the Icahn School of Medicine at Mount Sinai. Demographics, practice data, and current endometriosis screening practices were queried. Categorical and numerical variables were summarized by descriptive statistics, comparative analyses were conducted using chi-square tests. 118 respondents answered the survey (40.1% response rate) with 94.9% completion rate (n=112). The majority of respondents (57.5%, n=65) identified as females, physicians (64.3%, n=72), were within their first ten years of practice (59.0%, n=49), and practiced general GI (40.5%) at academic centers (79.3%). Most physicians had at least partial access to advanced practice provider support (59.4%, n=41). Most respondents (59.4%, n=63) reported they currently do not screen for endometriosis in patients with chronic GI symptoms. Of those who do not currently screen for endometriosis; 50.7% responded that they believed patients should be screened by other providers such as gynecologists or primary care physicians while 67.7% of respondents reported minimal to no knowledge of screening criteria for endometriosis. A minority of respondents (12.7%) believed screening for endometriosis was not clinically relevant for their practice and cited lack of time (12.7%) as a reason for not adopting screening practices. Providers were not more likely to screen based on gender, type of provider (gastropsychologist, advanced practice providers or physician) or subspecialty (e.g. inflammatory bowel disease, neurogastroenterology and motility) [Table 1]. The majority (72.1%) of providers reported they would be “extremely likely” or “somewhat likely” to screen for endometriosis after being presented with data on the high prevalence of chronic GI symptoms in patients with endometriosis [Figure 1]. The majority of respondents (72.1%) would be willing to administer a questionnaire (either by the provider or self-administered) comprising 5 items or fewer. Most providers (86.2%) practiced in an environment where referrals to a gynecologist would take fewer than 3 months. 43.7% of respondents were “extremely comfortable” or “somewhat comfortable” with ordering pelvic magnetic resonance imaging (MRI) or transvaginal ultrasounds if indicated while 40.7% of respondents were “extremely uncomfortable” and “somewhat uncomfortable”. Significantly more men were “extremely comfortable” or “somewhat comfortable” compared to women with ordering indicated imaging as next steps (68.2% versus 27.4%, p<0.001 ). Amongst the different subspecialties, providers subspecializing in IBD were the most comfortable (61.1%) with ordering imaging as a next step, but this was not statistically significant. Despite the high prevalence of GI symptoms in patients with surgically-confirmed endometriosis based on retrospective studies [11], there is currently no guidance for gastroenterologists on whether or how to screen patients. This is the first study examining current screening practices across the United States of endometriosis amongst gastroenterology providers. Most providers do not currently screen for endometriosis, with most respondents citing lack of knowledge of the condition and its effects on GI function. Providers were not more likely to screen depending on gender, type or subspecialty. There were varying degrees of comfort reported in terms of ordering imaging (such as pelvic MRI and transvaginal ultrasound) as next steps in an endometriosis work-up with male providers being significantly more comfortable than females. Future efforts on education of endometriosis amongst gastroenterology providers should balance resource utilization and broader discussions as a specialty as to whether we should order imaging when appropriate given that the number of gynecologists is projected to decrease by 7% from 2018 to 2030, while demand is expected to increase by 4% [13]. Strengths of our study include the high response rate, almost equal representation of male- and female- identifying gastroenterology providers and inclusion of gastropsychologists and advanced practitioners. Limitations include potential bias in respondents, lack of diversity in terms of practice setting as most respondents were practicing at tertiary academic centers with access to gynecology referrals taking fewer than three months, which may limit extrapolation to different practice settings. Although prospective data on efficacy of screening for endometriosis in a gastroenterology population is lacking (and may take years to operationalize and complete such a study), given the prevalence of endometriosis and negative impact on health-related quality of life, adopting a brief screening practice with the symptom-based questions highlighted in the consensus document in patients with chronic gastrointestinal symptoms may reduce diagnostic delay through appropriate and early work-up and referrals. After being presented with data on the high overlap of endometriosis and chronic gastrointestinal symptoms, most surveyed providers in our study would use a screening tool for endometriosis if it was available, highlighting the need for increased education and resources on this intersection on a national-level. Declarations Author Contribution All authors were involved in the conception, methodology and execution of study.YL wrote the main manuscript text. XW, LK and MS provided critical edits to manuscript.All authors have reviewed and approved the final draft to be submitted. Financial support: NA Potential competing interests: NA for this article All authors have reviewed and approved the final draft to be submitted. References Shafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1–15. doi: 10.1016/j.bpobgyn.2018.06.001 Maroun P, Cooper MJW, Reid GD, Keirse MJNC. Relevance of gastrointestinal symptoms in endometriosis. Aust N Z J ObstetGynaecol. 2009;49:411–414. https://doi.org/10. 1111/j. 1479- 828X. 2009. 01030.x. Nezhat C, Li A, Falik R et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218:549–562. Viganò D, Zara F, Usai P. Irritable bowel syndrome and endometriosis: New insights for old diseases. Dig Liver Dis 2018;50:213–219 Yang F, Wu Y, Hockey R; International Endometriosis Genetics Consortium; Doust J, Mishra GD, Montgomery GW, Mortlock S. Evidence of shared genetic factors in the etiology of gastrointestinal disorders and endometriosis and clinical implications for disease management. Cell Rep Med. 2023 Oct 30:101250. doi: 10.1016/j.xcrm.2023.101250. Epub ahead of print. PMID: 37909040. Greene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91:32–39. Macer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility.Obstet Gynecol Clin North Am. 2012;39:535–549. Grandi G, Toss A, Cortesi L, Botticelli L, Volpe A, Cagnacci A.The Association between Endometriomas and Ovarian Cancer:Preventive Effect of Inhibiting Ovulation and Menstruation during Reproductive Life. BioMed Res Int. 2015;2015:751571 Agarwal SK, Chapron C, Giudice LC et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220:354 .e1-354.e12 . https://doi.org/10. 1016/j. ajog. 2018.12. 039. Meurs-Szojda MM, Mijatovic V, Felt-Bersma RJ, et al. Irritable bowel syndrome and chronic constipation in patients with endometriosis. Colorectal Dis 2011;13:67–71. Yu V, McHenry N, Proctor S, Wolf J, Nee J. Gastroenterologist Primer: Endometriosis for Gastroenterologists. Dig Dis Sci. 2023;68(6):2482–2492. doi: 10.1007/s10620-022-07674-7 Singh SS, Missmer SA, Tu FF. Endometriosis and Pelvic Pain for the Gastroenterologist. Gastroenterol Clin North Am. 2022;51(1):195–211. doi: 10.1016/j.gtc.2021.10.012 Kramer KJ, Rhoads-Baeza ME, Sadek S, Chao C, Bell C, Recanati MA. Trends and Evolution in Women's Health Workforce in the First Quarter of the 21st Century. World J Gynecol Womens Health. 2022;5(5):622. doi: 10.33552/wjgwh.2022.05.000622 . Epub 2022 Apr 19. PMID: 35601601; PMCID: PMC9122235. Tables Table 1. Current Screening Practices for Endometriosis Yes No p value Gender Male 14 (34.1%) 25 (42.6%) 0.34 Female 27 (65.8%) 35 (58.3%) Type of Provider Physician 30 (73.2%) 38 (61.3%) 0.21 Gastropsychologist or APP 11 (26.8%) 24 (38.7%) Subspecialty, if MD General GI 12 (41.4%) 14 (38.9%) 0.44 IBD 10 (34.5%) 8 (22.2%) Liver 1 (3.4%) 3 (8.3%) Neurogastroenterology 5 (17.2%) 4 (11.1%) Pancreas 1 (3.4%) 5 (13.9%) Esophagus 0 (0.0%) 2 (5.6%) Current screening practices for endometriosis in patients with gastrointestinal symptoms by provider gender, type of provider and subspecialty. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Nov, 2024 Read the published version in Digestive Diseases and Sciences → Version 1 posted Editorial decision: Revision requested 21 Oct, 2024 Reviews received at journal 07 Oct, 2024 Reviewers agreed at journal 06 Oct, 2024 Reviewers invited by journal 18 Sep, 2024 Editor assigned by journal 17 Sep, 2024 Submission checks completed at journal 16 Sep, 2024 First submitted to journal 14 Sep, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5088830","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":368783085,"identity":"3c7fbab5-520f-4ea2-9b17-dfdbf04143c3","order_by":0,"name":"Yuying Luo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYJCCA0Asw8DAfADCZQbiBCK08DAwsIHVSRClhQGihccAooUQMLiRY3i44BdQ/fGerxs+tt2pk2/nPfjhAYNNvrwDTi0Gh2f2AbWcObvt5sy2ZxIGh/mSJRIY0iw3HsCjhbcHqOVG7rbbvG2HJQyYeQyAWg4bGDYQ1JLzDKxFvpnH+AdBLTw/wFrYwFoYDvOYgW2Rx+F9yTPPCg7zNkjwSJ45ZnZzxrnDkhuAWiwSDNIMDHBo4TuevPkzzx8bOb7jzc9ufCg7zC/ff8b45o8KGwN5HA5TOMBhwMDYhhEbQCsMDmDXIt/A/oCB4Q92KRwuGwWjYBSMgpEGAKn7XwV7Qc6tAAAAAElFTkSuQmCC","orcid":"","institution":"Mount Sinai West \u0026 Morningside","correspondingAuthor":true,"prefix":"","firstName":"Yuying","middleName":"","lastName":"Luo","suffix":""},{"id":368783087,"identity":"d83837ee-f41a-410b-af09-6da10802ff70","order_by":1,"name":"Xiao Jing Wang","email":"","orcid":"","institution":"Mayo Clinic","correspondingAuthor":false,"prefix":"","firstName":"Xiao","middleName":"Jing","lastName":"Wang","suffix":""},{"id":368783089,"identity":"0f5f74b7-ab7a-480a-8e1c-1f8b33db4f9e","order_by":2,"name":"Laurie A. 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Exploring Gastroenterology Attitudes Towards Endometriosis Screening","fulltext":[{"header":"Full Text","content":"\u003cp\u003eEndometriosis is a chronic painful condition affecting about 10% of reproductive-aged women [1]. Up to 90% of women with endometriosis (independent of the location) have concomitant irritable bowel syndrome-like (IBS) symptoms including chronic abdominal pain, bloating, and altered bowel movements [2,3]. The overlap with gastrointestinal (GI) symptoms is thought to be multifactorial with potential etiologies including visceral organ cross-talk, chronic low-grade inflammation, and dysbiosis [4] with newer research demonstrating evidence of shared risk loci in patients with endometriosis and GI conditions such as IBS [5].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUnfortunately, patients experience a diagnostic delay of between 4-11 years from symptom onset with a debilitating impact on health-related quality of life in addition to complications such as infertility and ovarian cancer [6,7,8]. This has led to a recent paradigm shift proposed by gynecologic societies to move away from the traditional reliance on a surgical diagnosis of endometriosis to one which focuses on patient symptoms (persistent and/or worsening cyclic or constant pelvic pain, dysmenorrhea, deep dyspareunia, cyclic dyschezia, dysuria or catamenial symptoms in other systems) and/or imaging (e.g. MRI and ultrasounds) [9].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eGastroenterologists have a potentially important role in reducing this diagnostic delay; in one study, more than 20% of patients with endometriosis presented for GI evaluation prior to a surgical diagnosis [10]. Current screening practices for endometriosis in GI clinic populations have not been evaluated and may impact the feasibility of future initiatives in this arena. Our aim was to explore the state of current screening practices and attitudes towards screening for endometriosis by gastroenterology providers with the goal of informing future feasibility and clinical studies.\u003c/p\u003e\n\u003cp\u003eAn anonymized exploratory survey was sent to a total of 294 providers (physicians, gastropsychologists, advanced practitioners) at three academic centers and two private practices caring for adult GI patients with geographic diversity. IRB approval was obtained from the Icahn School of Medicine at Mount Sinai. Demographics, practice data, and current endometriosis screening practices were queried. Categorical and numerical variables were summarized by descriptive statistics, comparative analyses were conducted using chi-square tests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e118 respondents answered the survey (40.1% response rate) with 94.9% completion rate (n=112). The majority of respondents (57.5%, n=65) identified as females, physicians (64.3%, n=72), were within their first ten years of practice (59.0%, n=49), and practiced general GI (40.5%) at academic centers (79.3%). Most physicians had at least partial access to advanced practice provider support (59.4%, n=41). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost respondents (59.4%, n=63) reported they currently do not screen for endometriosis in patients with chronic GI symptoms. Of those who do not currently screen for endometriosis; 50.7% responded that they believed patients should be screened by other providers such as gynecologists or primary care physicians while 67.7% of respondents reported minimal to no knowledge of screening criteria for endometriosis. A minority of respondents (12.7%) believed screening for endometriosis was not clinically relevant for their practice and cited lack of time (12.7%) as a reason for not adopting screening practices. Providers were not more likely to screen based on gender, type of provider (gastropsychologist, advanced practice providers or physician) or subspecialty (e.g. inflammatory bowel disease, neurogastroenterology and motility) [Table 1].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe majority (72.1%) of providers reported they would be “extremely likely” or “somewhat likely” to screen for endometriosis after being presented with data on the high prevalence of chronic GI symptoms in patients with endometriosis [Figure 1]. The majority of respondents (72.1%) would be willing to administer a questionnaire (either by the provider or self-administered) comprising 5 items or fewer. Most providers (86.2%) practiced in an environment where referrals to a gynecologist would take fewer than 3 months. 43.7% of respondents were “extremely comfortable” or “somewhat comfortable” with ordering pelvic magnetic resonance imaging (MRI) or transvaginal ultrasounds if indicated while 40.7% of respondents were “extremely uncomfortable” and “somewhat uncomfortable”. Significantly more men were “extremely comfortable” or “somewhat comfortable” compared to women with ordering indicated imaging as next steps (68.2% versus 27.4%, \u003cem\u003ep\u0026lt;0.001\u003c/em\u003e). Amongst the different subspecialties, providers subspecializing in IBD were the most comfortable (61.1%) with ordering imaging as a next step, but this was not statistically significant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the high prevalence of GI symptoms in patients with surgically-confirmed endometriosis based on retrospective studies [11], there is currently no guidance for gastroenterologists on whether or how to screen patients. This is the first study examining current screening practices across the United States of endometriosis amongst gastroenterology providers. Most providers do not currently screen for endometriosis, with most respondents citing lack of knowledge of the condition and its effects on GI function. \u0026nbsp;Providers were not more likely to screen depending on gender, type or subspecialty. There were varying degrees of comfort reported in terms of ordering imaging (such as pelvic MRI and transvaginal ultrasound) as next steps in an endometriosis work-up with male providers being significantly more comfortable than females. Future efforts on education of endometriosis amongst gastroenterology providers should balance resource utilization and broader discussions as a specialty as to whether we should order imaging when appropriate given that the number of gynecologists is projected to decrease by 7% from 2018 to 2030, while demand is expected to increase by 4% [13].\u003c/p\u003e\n\u003cp\u003eStrengths of our study include the high response rate, almost equal representation of male- and female- identifying gastroenterology providers and inclusion of gastropsychologists and advanced practitioners. Limitations include potential bias in respondents, lack of diversity in terms of practice setting as most respondents were practicing at tertiary academic centers with access to gynecology referrals taking fewer than three months, which may limit extrapolation to different practice settings.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough prospective data on efficacy of screening for endometriosis in a gastroenterology population is lacking (and may take years to operationalize and complete such a study), given the prevalence of endometriosis and negative impact on health-related quality of life, adopting a brief screening practice with the symptom-based questions highlighted in the consensus document in patients with chronic gastrointestinal symptoms may reduce diagnostic delay through appropriate and early work-up and referrals. After being presented with data on the high overlap of endometriosis and chronic gastrointestinal symptoms, most surveyed providers in our study would use a screening tool for endometriosis if it was available, highlighting the need for increased education and resources on this intersection on a national-level.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cb\u003eAuthor Contribution\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll authors were involved in the conception, methodology and execution of study.YL wrote the main manuscript text. XW, LK and MS provided critical edits to manuscript.All authors have reviewed and approved the final draft to be submitted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial support:\u0026nbsp;\u003c/strong\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePotential competing interests:\u0026nbsp;\u003c/strong\u003e NA for this article\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed and approved the final draft to be submitted.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eShafrir AL, Farland LV, Shah DK, et al. Risk for and consequences of endometriosis: A critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1\u0026ndash;15. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bpobgyn.2018.06.001\u003c/span\u003e\u003cspan address=\"10.1016/j.bpobgyn.2018.06.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaroun P, Cooper MJW, Reid GD, Keirse MJNC. Relevance of gastrointestinal symptoms in endometriosis. Aust N Z J ObstetGynaecol. 2009;49:411\u0026ndash;414. https://doi.org/10. 1111/j. 1479- 828X. 2009. 01030.x.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNezhat C, Li A, Falik R et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218:549\u0026ndash;562.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVigan\u0026ograve; D, Zara F, Usai P. Irritable bowel syndrome and endometriosis: New insights for old diseases. Dig Liver Dis 2018;50:213\u0026ndash;219\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang F, Wu Y, Hockey R; International Endometriosis Genetics Consortium; Doust J, Mishra GD, Montgomery GW, Mortlock S. Evidence of shared genetic factors in the etiology of gastrointestinal disorders and endometriosis and clinical implications for disease management. Cell Rep Med. 2023 Oct 30:101250. doi: 10.1016/j.xcrm.2023.101250. Epub ahead of print. PMID: 37909040.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGreene R, Stratton P, Cleary SD, Ballweg ML, Sinaii N. Diagnostic experience among 4,334 women reporting surgically diagnosed endometriosis. Fertil Steril. 2009;91:32\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacer ML, Taylor HS. Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis-associated infertility.Obstet Gynecol Clin North Am. 2012;39:535\u0026ndash;549.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrandi G, Toss A, Cortesi L, Botticelli L, Volpe A, Cagnacci A.The Association between Endometriomas and Ovarian Cancer:Preventive Effect of Inhibiting Ovulation and Menstruation during Reproductive Life. BioMed Res Int. 2015;2015:751571\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal SK, Chapron C, Giudice LC et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol. 2019;220:354\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e.e1-354.e12\u003c/span\u003e\u003cspan address=\"http://.e1-354.e12\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. https://doi.org/10. 1016/j. ajog. 2018.12. 039.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeurs-Szojda MM, Mijatovic V, Felt-Bersma RJ, et al. Irritable bowel syndrome and chronic constipation in patients with endometriosis. Colorectal Dis 2011;13:67\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu V, McHenry N, Proctor S, Wolf J, Nee J. Gastroenterologist Primer: Endometriosis for Gastroenterologists. Dig Dis Sci. 2023;68(6):2482\u0026ndash;2492. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10620-022-07674-7\u003c/span\u003e\u003cspan address=\"10.1007/s10620-022-07674-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingh SS, Missmer SA, Tu FF. Endometriosis and Pelvic Pain for the Gastroenterologist. Gastroenterol Clin North Am. 2022;51(1):195\u0026ndash;211. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.gtc.2021.10.012\u003c/span\u003e\u003cspan address=\"10.1016/j.gtc.2021.10.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKramer KJ, Rhoads-Baeza ME, Sadek S, Chao C, Bell C, Recanati MA. Trends and Evolution in Women's Health Workforce in the First Quarter of the 21st Century. World J Gynecol Womens Health. 2022;5(5):622. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.33552/wjgwh.2022.05.000622\u003c/span\u003e\u003cspan address=\"10.33552/wjgwh.2022.05.000622\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2022 Apr 19. PMID: 35601601; PMCID: PMC9122235.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable\u0026nbsp;1. Current Screening Practices for Endometriosis\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Taba\" border=\"1\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eYes\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNo\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003ep value\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 (34.1%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e25 (42.6%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.34\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e27 (65.8%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e35 (58.3%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eType of Provider\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePhysician\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e30 (73.2%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e38 (61.3%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.21\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGastropsychologist or APP\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e11 (26.8%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e24 (38.7%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSubspecialty, if MD\u003c/span\u003e\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eGeneral GI\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e12 (41.4%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e14 (38.9%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0.44\u003c/div\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eIBD\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e10 (34.5%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e8 (22.2%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eLiver\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.4%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e3 (8.3%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eNeurogastroenterology\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (17.2%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e4 (11.1%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003ePancreas\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e1 (3.4%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e5 (13.9%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" style=\"width: 46.9496%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003eEsophagus\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e0 (0.0%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 19.8939%;\"\u003e\n \u003cdiv class=\"SimplePara\"\u003e2 (5.6%)\u003c/div\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" style=\"width: 13.2626%;\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCurrent screening practices for endometriosis in patients with gastrointestinal symptoms by provider gender, type of provider and subspecialty.\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"endometriosis, women’s digestive health","lastPublishedDoi":"10.21203/rs.3.rs-5088830/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5088830/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eEndometriosis is a chronic painful condition affecting 10% of reproductive-aged women with a high prevalence of overlapping gastrointestinal symptoms. There is a significant diagnostic delay for endometriosis and current screening practices for endometriosis in gastroenterology clinic populations have not been evaluated. 112 gastroenterology providers (57.5% females, 64.3% physicians) completed an anonymized exploratory survey (40.1% response rate). Most respondents (59.4%) currently do not screen for endometriosis, but the majority (72.1%) reported they would be “extremely likely” or “somewhat likely” to screen for endometriosis after being presented with data on the high prevalence of chronic GI symptoms in patients with endometriosis.\u003c/p\u003e","manuscriptTitle":"Love Thy Neighbor? Exploring Gastroenterology Attitudes Towards Endometriosis Screening","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-05 11:33:16","doi":"10.21203/rs.3.rs-5088830/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-22T00:25:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-08T02:52:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319649254774493475575059928943482752310","date":"2024-10-07T00:02:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-09-18T05:40:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-09-17T22:58:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-09-17T02:53:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Digestive Diseases and Sciences","date":"2024-09-14T11:12:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"digestive-diseases-and-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ddsj","sideBox":"Learn more about [Digestive Diseases and Sciences](http://link.springer.com/journal/10620)","snPcode":"10620","submissionUrl":"https://submission.nature.com/new-submission/10620/3","title":"Digestive Diseases and Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b9d3e197-a3ca-488f-a9ce-20e5aae24a78","owner":[],"postedDate":"November 5th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T16:04:42+00:00","versionOfRecord":{"articleIdentity":"rs-5088830","link":"https://doi.org/10.1007/s10620-024-08740-y","journal":{"identity":"digestive-diseases-and-sciences","isVorOnly":false,"title":"Digestive Diseases and Sciences"},"publishedOn":"2024-11-21 15:58:07","publishedOnDateReadable":"November 21st, 2024"},"versionCreatedAt":"2024-11-05 11:33:16","video":"","vorDoi":"10.1007/s10620-024-08740-y","vorDoiUrl":"https://doi.org/10.1007/s10620-024-08740-y","workflowStages":[]},"version":"v1","identity":"rs-5088830","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5088830","identity":"rs-5088830","version":["v1"]},"buildId":"WvIrzKhiLBfengagbw6Ux","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}