Irritable bowel syndrome, endometriosis and polycystic ovary syndrome: is there a link?

Ashwath Narayan Ramji
In: International Journal of Research in Medical Sciences · 2019 · vol. 7(6) , pp. 2449 · doi:10.18203/2320-6012.ijrms20192532 · W2947026358
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This case report examines a young female patient with the co-occurring conditions of PCOS, IBS, and endometriosis presenting with chronic pelvic pain.

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This paper presents a clinical case report of a young female with chronic pelvic pain and the triad of polycystic ovary syndrome, irritable bowel syndrome, and endometriosis, discussing the question of whether these conditions share a common denominator such as visceral hypersensitivity and co-existence. It frames endometriosis and IBS as common causes of chronic pelvic pain and notes that the association of PCOS in this context is not well characterized. The main limitation is that, as a report of a single patient, it does not provide systematic prevalence estimates or causal evidence. Relevance to endometriosis: the paper explicitly centers on a patient with endometriosis and discusses the potential linkage and co-occurrence of endometriosis with IBS-related visceral hypersensitivity, though its primary contribution is a case-based narrative rather than new mechanistic data. This paper is centrally about endometriosis — it reports a case where endometriosis co-occurs with IBS and PCOS in the setting of chronic pelvic pain.

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Abstract

Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as well as the gastroenterologist and general surgeon. Highlighted by increased visceral hypersensitivity, endometriosis and irritable bowel syndrome (IBS) are the most common causes or chronic unrelenting pelvic pain. Recently, the similarities between the two conditions has begged the question as to whether there is any common denominator between the two conditions and their likely co-existence and mismanagement. Further, the association of polycystic ovary syndrome (PCOS) in this cohort remains definitively uncharacterized. This report details a young female patient with the triad of POCS, IBS and endometriosis presenting with chronic pelvic pain.
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Irritable bowel syndrome, endometriosis and polycystic ovary syndrome: is there a link? DOI: https://doi.org/10.18203/2320-6012.ijrms20192532Keywords: Chronic pelvic pain, Chocolate cyst, Endometriosis, Irritable bowel syndrome, Metabolic Syndrome, Pelvic inflammatory disease, Polycystic kidney disease, Visceral hypersensitivityAbstract Chronic pelvic pain is a common yet difficult problem to manage, plaguing the gynecologist as well as the gastroenterologist and general surgeon. Highlighted by increased visceral hypersensitivity, endometriosis and irritable bowel syndrome (IBS) are the most common causes or chronic unrelenting pelvic pain. Recently, the similarities between the two conditions has begged the question as to whether there is any common denominator between the two conditions and their likely co-existence and mismanagement. Further, the association of polycystic ovary syndrome (PCOS) in this cohort remains definitively uncharacterized. This report details a young female patient with the triad of POCS, IBS and endometriosis presenting with chronic pelvic pain. Metrics References Latthe P, Latthe M, Say L, Gulmezoglu M, Khan KS. WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Heal. 2006;6:177. Seaman HE, Ballard KD, Wright JT, de Vries CS. Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study-part 2. BJOG. 2008;115:1392-6. Issa B, Onon TS, Agrawal A, Shekhar C, Morris J, Hamdy S, et al. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012;61:367-72. Issa B, Ormesher L, Whorwell PJ, Shah M, Hamdy S. Endometriosis and irritable bowel syndrome: a dilemma for the gynaecologist and gastroenterologist. Obstetrician Gynaecol. 2016;18:9-16. Mathur R, Ko A, Hwang LJ, Low K, Azziz R, Pimentel M. Polycystic ovary syndrome is associated with an increased prevalence of irritable bowel syndrome. Digest Dis Sci. 2010 Apr 1;55(4):1085-9. Li MQ, Luo XZ, Meng YH, Mei J, Zhu XY, Jin LP, et al. CXCL8 enhances proliferation and growth and reduces apoptosis in endometrial stromal cells in an autocrine manner via a CXCR1-triggered PTEN/AKT signal pathway. Human Reprod. 2012;27:2107-16. Kellow JE, Delvaux M, Azpiroz F, Camilleri M, Quigley EM, Thompson DG. Principles of applied neurogastroenterology: physiology/motility-sensation. Gut 1999;45 Suppl 2:II17-24. Drossman DA, Powell DW, Sessions JT Jr. The irritable bowel syndrome. Gastroenterol. 1977;73(4 Pt 1):811-22. Abbas S, Ihle P, Köster I, Schubert I. Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany. Euro J Obst Gynecol Reprod Biol. 2012 Jan 1;160(1):79-83. Gupta S, Harlev A, Agarwal A. Endometriosis and PCOS: Two major pathologies linked to oxidative stress in women. Sematic Scholar. 2015. Shah D, Nagarajan N. Luteal Insufficiency in first trimester. Indian J Endocrinol Metab. 2013 Jan-Feb;17(1):44-9.

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endometriosischronic_pelvic_painirritable_bowel_syndrome

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