Gastric Mucosal Atrophy and Serum Biomarker Alterations in Women with Endometriosis: A Case-Control Study

Endometriosis is a chronic oestrogen-dependent inflammatory disorder that affects approximately 10% of women of reproductive age and is frequently accompanied by gastrointestinal (GI) symptoms. Despite this overlap, gastric mucosal histopathology in this population has not been systematically investigated. In this retrospective case–control study conducted between June 2022 and December 2023, 28 women with laparoscopically or radiologically confirmed endometriosis and 41 controls with similar GI symptoms underwent upper GI endoscopy with biopsy. Demographic data, laboratory results (CRP and tumour markers), and histopathological findings were assessed. Statistical analyses included t-test, Mann–Whitney U, chi-square, and correlation analyses. Women with endometriosis had significantly higher CRP (4.79 vs. 1.98 mg/L, p = 0.022) and CA19-9 [median (IQR): 11.35 (8.75–17.14) vs. 6.77 (4.34–9.25) U/mL, p = 0.033] levels compared with controls. Gastric mucosal atrophy was more prevalent in the endometriosis group (25.0% vs. 2.4%, p = 0.013), while Helicobacter pylori infection and intestinal metaplasia did not differ. Endometriosis correlated positively with CA19-9 and gastric atrophy. Endometriosis is associated with systemic inflammatory alterations and an increased prevalence of gastric mucosal atrophy. These findings suggest extra-pelvic GI involvement and support multidisciplinary management of affected women. In practice, women with endometriosis and persistent upper gastrointestinal symptoms may benefit from coordinated gynecology–gastroenterology evaluation, with endoscopic assessment considered when alarm features or unexplained laboratory abnormalities are present. Similar content being viewed by others

Maybin JA, Critchley HOD. Menstrual physiology: implications for endometrial pathology and beyond. Hum Reprod Update. 2015;21(6):748–61. Karamian A, Paktinat S, Esfandyari S, Nazarian H, Ziai SA, Zarnani AH, et al. Pyrvinium pamoate induces in-vitro suppression of IL-6 and IL-8 produced by human endometriotic stromal cells. Hum Exp Toxicol. 2021;40(5):649–60. Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Hum Reprod Open. 2022;2022(2):hoac009. DiVasta AD, Vitonis AF, Laufer MR, Missmer SA. Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood. Am J Obstet Gynecol. 2018;218(3):324.e1-324.e11. Maroun P, Cooper MJW, Reid GD, Keirse MJNC. Relevance of gastrointestinal symptoms in endometriosis. Aust N Z J Obstet Gynaecol. 2009;49(4):411–4. Laschke MW, Menger MD. The gut microbiota: a puppet master in the pathogenesis of endometriosis? Am J Obstet Gynecol. 2016;215(1):68.e1-68.e4. Yang F, Wu Y, Hockey R, Doust J, Mishra GD, Montgomery GW, et al. Evidence of shared genetic factors in the etiology of gastrointestinal disorders and endometriosis. Cell Rep Med. 2023;4(9):101250. Vodolazkaia A, Bossuyt X, Fassbender A, et al. A high sensitivity assay is more accurate than a classical assay for the measurement of plasma CRP levels in endometriosis. Reprod Biol Endocrinol. 2011;9:113. Topdagi Yilmaz EP, Topdagi YE, Ra A, Kumtepe Y. The relationship between C-reactive protein, carbohydrate antigen 125, and hematological parameters to endometriotic nodule localization in pelvis. J Chin Med Assoc. 2020;83(6):577–81. Harada T, Kubota T, Aso T. Usefulness of CA19-9 versus CA125 for the diagnosis of endometriosis. Fertil Steril. 2002;78(4):733–9. Somigliana E, Viganò P, Tirelli AS, Felicetta I, Torresani E, Vignali M, et al. Use of the concomitant serum dosage of CA125, CA19-9 and interleukin-6 to detect the presence of endometriosis. Hum Reprod. 2004;19(8):1871–6. Shen A, Xu S, Ma Y, et al. Diagnostic value of serum CA125, CA19-9 and CA15-3 in endometriosis: a meta-analysis. J Int Med Res. 2015;43(5):599–609. Tahir T, Sawera S, Ilyas M, Gasem J. Endometriosis can cause gastric obstruction. Eur J Case Rep Intern Med. 2025;12(6):005239.

We acknowledge the use of ChatGPT (OpenAI GPT-5, San Francisco, CA, USA) to assist in language editing, grammar improvement, and formatting of the manuscript. All authors reviewed and verified the content for accuracy and accept full responsibility for the final version. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author information Authors and Affiliations Contributions Aykut Özturan (first and corresponding author): Conceptualization, Methodology, Investigation, Data curation, Formal analysis, Writing – original draft. Gökhan Aydın: Methodology, Investigation, Data curation, Writing – review & editing. Sefer Aslan: Investigation, Clinical data collection, Writing – review & editing. Ersin Kuloğlu: Investigation, Histopathological evaluation, Data interpretation. Kubilay İşsever: Formal analysis, Statistical analysis, Validation, Writing – review & editing. Ahmet Cumhur Dülger (senior author): Supervision, Project administration, Critical revision of the manuscript, Final approval of the version to be published. Corresponding author Ethics declarations Competing Interests The authors declare no conflicts of interest. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions Springer 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. About this article Cite this article Özturan, A., Aydin, G., Aslan, S. et al. Gastric Mucosal Atrophy and Serum Biomarker Alterations in Women with Endometriosis: A Case-Control Study. Reprod. Sci. (2026). https://doi.org/10.1007/s43032-026-02098-4 Received: Accepted: Published: Version of record: DOI: https://doi.org/10.1007/s43032-026-02098-4