Association Between Pelvic Endometriosis and Inflammatory Bowel Disease in Females in Reproductive Age: Cross-sectional study

Association Between Pelvic Endometriosis and Inflammatory Bowel Disease in Females in Reproductive Age: Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association Between Pelvic Endometriosis and Inflammatory Bowel Disease in Females in Reproductive Age: Cross-sectional study Amr Mansy, Marwa Saad, Essam Bedewy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8921054/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 18 You are reading this latest preprint version Abstract Background: Endometriosis is a pathological state distinguished by the endometrial-like tissue located in ectopic regions leading to chronic inflammation, adhesions, and scar tissue potentially distorting a woman's pelvic anatomy. Objective: To study the association between pelvic endometriosis and Inflammatory Bowel Disease(IBD) using fecal calprotectin analysis in cases diagnosed by laparoscope. Methods: This cross-sectional study was conducted on 50 patients of reproductive age who have symptoms like diarrhea, constipation, or change in bowel habits, symptoms of dysmenorrhea, dysuria, or dyschezia, and all cases were subjected to laparoscopy and diagnosed as pelvic endometriosis. Results: The fecal calprotectin level varied from 9.0 – 70.0 μg/g with a mean level of 24.36 ± 14.07 μg/g. For correlating calprotectin level and endometriotic cyst, the studied group was stratified according to the localization of cysts. There was a significant statistical correlation between calprotectin level and endometriotic cyst among the studied 1 st (one cyst) and 2 nd group (2 cysts, P=0.015). Conclusion: Calprotectin levels were significantly associated with endometriosis severity. Moreover, severe endometriosis adhesions increased calprotectin levels. These findings point up the IBD-endometriosis possible association. Pelvic Endometriosis IBD Calprotectin Introduction Endometriosis is defined as “the presence of endometrial-like tissue (glands and stroma) in ectopic locations, primarily the pelvic peritoneum, ovaries, and rectovaginal septum, which induces a chronic inflammatory reaction, scar tissue, and adhesions that may distort a woman’s pelvic anatomy”[ 1 ].The main complaints among patients with endometriosis include pelvic pain, dysmenorrhea, and dyspareunia. Therefore, endometriosis is typically linked to a poorer quality of life compared to the general population [ 2 ]. The gold standard diagnostic tool for confirming Endometriosis is laparoscopic inspection and confirmation by histologic analysis following a biopsy. Furthermore, obtaining the rASRM stage may also be achieved through the laparoscopic evaluation [ 3 ]. Inflammatory Bowel Disease (IBD) is a well-documented chronic inflammatory disease of the gastrointestinal tract. Clinically, two major subtypes of IBD are identified; Crohn’s Disease (CD) and Ulcerative Colitis (UC). The typical clinical picture of IBD is characterized by episodic abdominal pain, diarrhea, and bloody stools. Other features of IBD include apparent weight loss, mucosal inflammation, and the presence of blood-loss anemia, fistulas, and ulcers. Fistulas are more common than ulcers in CD [ 4 ]. Clinical findings alone can only be suggestive of CD. Diagnostic methods, however, include a variety of tools. The utilization of radiological imaging, endoscopic assessment, and pathology reports are crucial for confirming the diagnosis of CD [ 5 ]. Fecal calprotectin is commonly used as a screening test for IBD. It has a high sensitivity and an excellent negative predictive value. Thus, patients with suggestive clinical manifestations and high fecal calprotectin levels are prioritized for endoscopic assessment. The level of fecal calprotectin may also be affected by the patient’s age and prescribed medications. Additionally, it can be used to monitor response to treatment as well as prediction of relapse or sustained remission [ 6 ]. Accordingly, this study aimed to evaluate the association between pelvic endometriosis and IBD using fecal calprotectin in cases diagnosed by laparoscope. Patients and methods Study design This cross-sectional study was conducted on 50 endometriosis cases diagnosed by laparoscopy from El-Shatby University Hospitals, Alexandria, Egypt. Inclusion criteria: 1- Female patients of reproductive age. 2- Females in any parity. 3- Females have symptoms like diarrhea, constipation, or change in bowel habits, Symptoms of dysmenorrhea, dysuria, or dyschezia. 4-All cases suspected of laparoscopy and diagnosed as pelvic endometriosis. 5- Patients or guardians informed consent for patients under 21 years old. Exclusion criteria: 1- Cases on hormonal therapy. Methods: All cases were subjected to the following: detailed history, examination, pelvic examination to exclude any other pathology, and laparoscopy for all cases. Pre-laparoscopic transvaginal ultrasound to diagnose and measure endometriotic cysts confirmed by laparoscopy. Location of endometriotic cysts. Unilateral endometriotic cyst ≥ 3 cm. Bilateral endometriotic cysts ≥ 3 cm. Other laparoscopic findings include peritoneal and pelvic endometriotic spots and adnexal and pelvic adhesions. Adhesions considered: Minimal : if adhesions between one adnexa and ovarian fossa, pelvic wall, or back of the uterus. Moderate : if bilateral adhesions of both adnexa to the lateral pelvic wall or the uterus. Severe : if kissing ovaries, colonic adhesions, partial or complete obliteration of Douglas pouch. Results of laparoscopy were classified according to the revised American Society of Reproductive Medicine Classification (rASRM) which is the most accepted classification system for endometriosis. The classification is based on a laparoscopic evaluation of the patient. The extent of endometriosis is summarized as a final stage (ranging from stage I to stage IV) [ 7 ].In the revised rASRM, the disease stage was classified with each score classed as 1–5, 6–15, 16–40, and above 40,and each score was categorized as mild, moderate, severe, minimum, or both. [ 7 ]. Fecal calprotectin was measured and considered positive if > 50 µg/g; those proved to be positive > 100 µg/g were subjected to colonoscopy and biopsy to document the presence of IBD. Statistical analysis: The computation was performed utilizing IBM SPSS software program version 20.0 on the inputted data. (IBM Corp., Armonk, New York). Qualitative data were described in terms of percentages and numbers. Utilizing the Shapiro-Wilk test, the normality of the distribution was confirmed. The range (minimum and maximum values), average, SD, median, and Interquartile Range (IQR) were employed to characterize the quantitative data. At the five percent significance level, the derived results were deemed significant. The Kruskal-Wallis test was employed to compare abnormally distributed quantitative variables across more than two studied groups, while Post Hoc (Dunn's multiple comparisons test) was utilized to analyze pair wise comparisons. Results Age of the patients varied between 16–40 years old with a mean age of 26.50 ± 5.76 years. The highest percentage of cases aged less than 30 years (Table 1). Laparoscopic results showed the absence of endometriotic cysts in 56%, 38% with unilateral cysts, and 6% with bilateral cysts. Moreover, pelvic adhesions demonstrated minimal adhesions in 46% and severe adhesions in 6% (Table 2). The fecal calprotectin level varied between 9.0–70.0 µg/g with a mean level of 24.36 ± 14.07 µg/g (Table 3). Assessing calprotectin levels in different cysts revealed a statistically significant difference among calprotectin levels and endometriotic cysts, particularly; among no cysts and unilateral cysts groups (p = 0.015) (Table 4). Assessing the differences between adhesion levels and calprotectin level demonstrated a significant difference among the groups. Post Hoc test showed a significant difference between calprotectin level and pelvic adhesions among the minimal and severe adhesion cases (p = 0.005) and moderate and severe adhesion cases (p = 0.014) (Table 5). Assessing the differences between pelvic endometriosis and IBD (fecal calprotectin level) showed a statistically significant difference between calprotectin levels and endometriosis among rASM stage I and III (p = 0.006) and Stage II and III (p = 0.041) (Table 6). Discussion The current study aimed to investigate the association between pelvic endometriosis and IBD. Specifically, calprotectin as a possible predictive biomarker for IBD severity and was also found significantly associated with cysts and adhesions of endometriosis. The average calprotectin level in our study participants was 24.3 µg/g and hit the highest in patients with unilateral cysts (24.0 µg/g). A statistically significant difference between levels of calprotectin (IBD severity) and underlying cysts (severity of endometriosis) was found. Similarly, a recently published conference abstract highlighted the co-existence between IBD and endometriosis. The study compared the clinical manifestations of patients suffering from IBD and endometriosis concurrently versus control subjects having only endometriosis. The authors report that dyspareunia and dyschezia were more predominant among cases than control (73% VS 45%; p-value: 0.03). Hence, it’s recommended that endometriosis patients presenting with dyspareunia and/or dyschezia should undergo investigations for concurrent IBD, and vice versa [ 8 ]. Investigating calprotectin levels and the adhesions of endometriosis, revealed calprotein levels higher among the severe cases (60 µg/g). Similar findings related to the rASRM staging were demonstrated where more severe cases showed significantly larger mean calprotectin levels. Although no previous studies have investigated the degree of adhesion and IBD severity, one study has demonstrated that endometriosis can increase the risk of IBD almost 2 folds compared to a healthy population [ 9 ]. An earlier systematic review published in 2015 reports that among major chronic diseases, IBD can be predicted in patients with endometriosis [ 10 ]. Another study published in 2019 investigated the association between endometriosis and a comprehensive set of autoimmune diseases and demonstrated an IBD-endometriosis significant association [ 11 ]. Conclusion Our study highlighted a significant association between calprotectin levels and endometriosis severity. Patients with severe adhesions showed high calprotectin levels. These findings emphasize the potential role of calprotectin in predicting IBD in patients with endometriosis. Abbreviations CD: Crohn’s Disease IBD: Inflammatory Bowel Disease IQR: Interquartile Range rASRM: American Society of Reproductive Medicine Classification UC: Ulcerative Colitis Declarations Ethics approval and consent to participate This study was approved by the Faculty of Medicine-Alexandria University, Alexandria, Egypt. ethical committee in 2020. The study was conducted according to the Declaration of Helsinki. Consent for publication Not applicable. Availability of data and material All data are available Competing interests The authors declare no competing interests in this research. Funding No fund was received for this research. Authors' contributions All authors contributed equally to finalize this research. Acknowledgement Not applicable. References Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698–2704 Gordts S, Koninckx P, Brosens I (2017) Pathogenesis of deep endometriosis. Fertil Steril 108(6):872–885 Dessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB (2003) Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril 79(4):1023–1027 Abraham C, Dulai PS, Vermeire S, Sandborn WJ (2017) Lessons learned from trials targeting cytokine pathways in patients with inflammatory bowel diseases. Gastroenterology 152(2):374–388 Gajendran M, Loganathan P, Catinella AP, Hashash JG (2018) A comprehensive review and update on Crohn's disease. Dis Mon 64(2):20–57 Ayling RM, Kok K (2018) Fecal calprotectin. Advances in clinical chemistry. ; 87:161 – 90 Vercellini P, Viganò P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Reviews Endocrinol 10(5):261–275 Karakan T, Karatas A, Cindoruk M, Gulbahar O (2023) P306 Serum tryptophan metabolites as a biomarker for disease severity in patients with IBD. J Crohn's Colitis 17(Supplement1):i450 Jess T, Frisch M, Jørgensen KT et al (2011) Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut Published Online First: 19 Dec. 10.1136/gutjnl-2011-301095 Kvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, Missmer SA (2015) Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update 21(4):500–516 Shigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM (2019) The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update 25(4):486–503 Jess T, Frisch M, Jørgensen KT, Pedersen BV, Nielsen NM (2012) Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut 61(9):1279–1283 Tables Table (1): Age distribution of the cases (n = 50) Age (years) No. % <30 35 70.0 ≥30 15 30.0 Min. – Max. 16.0 – 40.0 Mean ± SD. 26.50 ± 5.76 Median (IQR) 26.0 (22.0 – 31.0) IQR: Inter quartile range, SD: Standard deviation Table (2): Distribution of endometriosis cysts and pelvic adhesions among the cases (n = 50) * Minimal : if adhesions between one adnexa and ovarian fossa, pelvic wall, or back of the uterus, Moderate: if bilateral adhesions of both adnexa to the lateral pelvic wall or the uterus, Severe: if kissing ovaries, colonic adhesions, partial or complete obliteration of Douglas pouch. Table (3): Calprotectin level among the selected cases (n = 50) Min. – Max. Mean ± SD. Median (IQR) Calprotectin level 9.0 – 70.0 24.36 ± 14.07 20.50 (13.0 – 34.0) IQR: Inter quartile range, SD: Standard deviation Table (4): Differences among endometriotic cyst groups and calprotectin levels (n =50) Cyst H p No (n = 28) Unilateral (n = 19) Bilateral (n = 3) Calprotectin Min. – Max. 9.0 – 48.0 10.0 – 70.0 12.0 – 22.0 6.158 * 0.046 * Mean ± SD. 20.46 ± 11.03 31.05 ± 16.62 18.33 ± 5.51 Median 17.50 24.0 21.0 Post Hoc test p 1 =0.015 * , p 2 =0.967, p 3 =0.230 SD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn's test for multiple comparisons) was employed to compare each pair of groups. p1: the p-value obtained from comparing No to Unilateral; p2: the p-value obtained from comparing No to Bilateral; p3: the p-value obtained from comparing Unilateral to Bilateral; *Statistically significant at a p-value < 0.05 Table (5): Differences among levels of adhesions and calprotectin levels (n=50) Adhesion H p Minimal (n = 23) Moderate (n = 24) Severe (n = 3) Calprotectin Min. – Max. 10.0 – 48.0 9.0 – 46.0 42.0 – 70.0 7.728 * 0.021 * Mean ± SD. 20.35 ± 9.38 24.08 ± 12.74 57.33 ± 14.19 Median 20.0 19.50 60.0 Post Hoc Test p 1 =0.506, p 2 =0.005 * , p 3 =0.014 * SD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn's test for multiple comparisons) was employed to compare each pair of groups. p1: p-value representing the comparison between minimal and moderate adhesion; p2: p-value representing the comparison between minimal and severe adhesion; and p3: p-value representing the comparison between moderate and severe adhesion. *High significant difference p < 0.05. Table (6): Differences among rASRM stages and calprotectin levels (n=50) rASRM stage H p I (n=3) II (n=36) III (n=11) Calprotectin Min. – Max. 10.0 – 14.0 9.0 – 48.0 12.0 – 70.0 8.545 * 0.014 * Mean ± SD. 11.67 ± 2.08 22.28 ± 11.42 34.64 ± 18.26 Median 11.0 19.0 34.0 Post Hoc Test p 1 =0.073, p 2 =0.006 * , p 3 =0.041 * SD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn's test for multiple comparisons) was employed to compare each pair of groups; p1: p-value for comparison among I and II; p2: p-value for comparison among I and III; and p3: p-value for comparison among II and III; the Post Hoc Test (Dunn's for multiple comparisons test) was applied to each of the two groups. *High significant difference p < 0.05. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviewers agreed at journal 18 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 15 Mar, 2026 Reviews received at journal 15 Mar, 2026 Reviewers agreed at journal 15 Mar, 2026 Reviews received at journal 14 Mar, 2026 Reviews received at journal 13 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers agreed at journal 10 Mar, 2026 Reviewers invited by journal 10 Mar, 2026 Editor assigned by journal 28 Feb, 2026 Submission checks completed at journal 25 Feb, 2026 First submitted to journal 19 Feb, 2026 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. 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Therefore, endometriosis is typically linked to a poorer quality of life compared to the general population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe gold standard diagnostic tool for confirming Endometriosis is laparoscopic inspection and confirmation by histologic analysis following a biopsy. Furthermore, obtaining the rASRM stage may also be achieved through the laparoscopic evaluation [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInflammatory Bowel Disease (IBD) is a well-documented chronic inflammatory disease of the gastrointestinal tract. Clinically, two major subtypes of IBD are identified; Crohn\u0026rsquo;s Disease (CD) and Ulcerative Colitis (UC). The typical clinical picture of IBD is characterized by episodic abdominal pain, diarrhea, and bloody stools. Other features of IBD include apparent weight loss, mucosal inflammation, and the presence of blood-loss anemia, fistulas, and ulcers. Fistulas are more common than ulcers in CD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eClinical findings alone can only be suggestive of CD. Diagnostic methods, however, include a variety of tools. The utilization of radiological imaging, endoscopic assessment, and pathology reports are crucial for confirming the diagnosis of CD [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFecal calprotectin is commonly used as a screening test for IBD. It has a high sensitivity and an excellent negative predictive value. Thus, patients with suggestive clinical manifestations and high fecal calprotectin levels are prioritized for endoscopic assessment. The level of fecal calprotectin may also be affected by the patient\u0026rsquo;s age and prescribed medications. Additionally, it can be used to monitor response to treatment as well as prediction of relapse or sustained remission [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccordingly, this study aimed to evaluate the association between pelvic endometriosis and IBD using fecal calprotectin in cases diagnosed by laparoscope.\u003c/p\u003e"},{"header":"Patients and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted on 50 endometriosis cases diagnosed by laparoscopy from El-Shatby University Hospitals, Alexandria, Egypt.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion criteria:\u003c/h3\u003e\n\u003cp\u003e1- Female patients of reproductive age.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2-\u003c/b\u003eFemales in any parity.\u003c/p\u003e \u003cp\u003e3- Females have symptoms like diarrhea, constipation, or change in bowel habits, Symptoms of dysmenorrhea, dysuria, or dyschezia.\u003c/p\u003e \u003cp\u003e4-All cases suspected of laparoscopy and diagnosed as pelvic endometriosis.\u003c/p\u003e \u003cp\u003e5- Patients or guardians informed consent for patients under 21 years old.\u003c/p\u003e\n\u003ch3\u003eExclusion criteria:\u003c/h3\u003e\n\u003cp\u003e \u003cb\u003e1-\u003c/b\u003e Cases on hormonal therapy.\u003c/p\u003e\n\u003ch3\u003eMethods:\u003c/h3\u003e\n\u003cp\u003eAll cases were subjected to the following: detailed history, examination, pelvic examination to exclude any other pathology, and laparoscopy for all cases. Pre-laparoscopic transvaginal ultrasound to diagnose and measure endometriotic cysts confirmed by laparoscopy. Location of endometriotic cysts. Unilateral endometriotic cyst\u0026thinsp;\u0026ge;\u0026thinsp;3 cm. Bilateral endometriotic cysts\u0026thinsp;\u0026ge;\u0026thinsp;3 cm. Other laparoscopic findings include peritoneal and pelvic endometriotic spots and adnexal and pelvic adhesions.\u003c/p\u003e \u003cp\u003eAdhesions considered: \u003cb\u003eMinimal\u003c/b\u003e: if adhesions between one adnexa and ovarian fossa, pelvic wall, or back of the uterus. \u003cb\u003eModerate\u003c/b\u003e: if bilateral adhesions of both adnexa to the lateral pelvic wall or the uterus. \u003cb\u003eSevere\u003c/b\u003e: if kissing ovaries, colonic adhesions, partial or complete obliteration of Douglas pouch.\u003c/p\u003e \u003cp\u003eResults of laparoscopy were classified according to the revised American Society of Reproductive Medicine Classification (rASRM) which is the most accepted classification system for endometriosis. The classification is based on a laparoscopic evaluation of the patient. The extent of endometriosis is summarized as a final stage (ranging from stage I to stage IV) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].In the revised rASRM, the disease stage was classified with each score classed as 1\u0026ndash;5, 6\u0026ndash;15, 16\u0026ndash;40, and above 40,and each score was categorized as mild, moderate, severe, minimum, or both. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFecal calprotectin was measured and considered positive if\u0026thinsp;\u0026gt;\u0026thinsp;50 \u0026micro;g/g; those proved to be positive\u0026thinsp;\u0026gt;\u0026thinsp;100 \u0026micro;g/g were subjected to colonoscopy and biopsy to document the presence of IBD.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis:\u003c/h2\u003e \u003cp\u003eThe computation was performed utilizing IBM SPSS software program version 20.0 on the inputted data. (IBM Corp., Armonk, New York). Qualitative data were described in terms of percentages and numbers. Utilizing the Shapiro-Wilk test, the normality of the distribution was confirmed. The range (minimum and maximum values), average, SD, median, and Interquartile Range (IQR) were employed to characterize the quantitative data. At the five percent significance level, the derived results were deemed significant. The Kruskal-Wallis test was employed to compare abnormally distributed quantitative variables across more than two studied groups, while Post Hoc (Dunn's multiple comparisons test) was utilized to analyze pair wise comparisons.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eAge of the patients varied between 16\u0026ndash;40 years old with a mean age of 26.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.76 years. The highest percentage of cases aged less than 30 years (Table\u0026nbsp;1).\u003c/p\u003e \u003cp\u003eLaparoscopic results showed the absence of endometriotic cysts in 56%, 38% with unilateral cysts, and 6% with bilateral cysts. Moreover, pelvic adhesions demonstrated minimal adhesions in 46% and severe adhesions in 6% (Table\u0026nbsp;2).\u003c/p\u003e \u003cp\u003eThe fecal calprotectin level varied between 9.0\u0026ndash;70.0 \u0026micro;g/g with a mean level of 24.36\u0026thinsp;\u0026plusmn;\u0026thinsp;14.07 \u0026micro;g/g (Table\u0026nbsp;3).\u003c/p\u003e \u003cp\u003eAssessing calprotectin levels in different cysts revealed a statistically significant difference among calprotectin levels and endometriotic cysts, particularly; among no cysts and unilateral cysts groups (p\u0026thinsp;=\u0026thinsp;0.015) (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003eAssessing the differences between adhesion levels and calprotectin level demonstrated a significant difference among the groups. Post Hoc test showed a significant difference between calprotectin level and pelvic adhesions among the minimal and severe adhesion cases (p\u0026thinsp;=\u0026thinsp;0.005) and moderate and severe adhesion cases (p\u0026thinsp;=\u0026thinsp;0.014) (Table\u0026nbsp;5).\u003c/p\u003e \u003cp\u003eAssessing the differences between pelvic endometriosis and IBD (fecal calprotectin level) showed a statistically significant difference between calprotectin levels and endometriosis among rASM stage I and III (p\u0026thinsp;=\u0026thinsp;0.006) and Stage II and III (p\u0026thinsp;=\u0026thinsp;0.041) (Table\u0026nbsp;6).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to investigate the association between pelvic endometriosis and IBD. Specifically, calprotectin as a possible predictive biomarker for IBD severity and was also found significantly associated with cysts and adhesions of endometriosis. The average calprotectin level in our study participants was 24.3 \u0026micro;g/g and hit the highest in patients with unilateral cysts (24.0 \u0026micro;g/g). A statistically significant difference between levels of calprotectin (IBD severity) and underlying cysts (severity of endometriosis) was found. Similarly, a recently published conference abstract highlighted the co-existence between IBD and endometriosis. The study compared the clinical manifestations of patients suffering from IBD and endometriosis concurrently versus control subjects having only endometriosis. The authors report that dyspareunia and dyschezia were more predominant among cases than control (73% VS 45%; p-value: 0.03). Hence, it\u0026rsquo;s recommended that endometriosis patients presenting with dyspareunia and/or dyschezia should undergo investigations for concurrent IBD, and vice versa [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInvestigating calprotectin levels and the adhesions of endometriosis, revealed calprotein levels higher among the severe cases (60 \u0026micro;g/g). Similar findings related to the rASRM staging were demonstrated where more severe cases showed significantly larger mean calprotectin levels.\u003c/p\u003e \u003cp\u003eAlthough no previous studies have investigated the degree of adhesion and IBD severity, one study has demonstrated that endometriosis can increase the risk of IBD almost 2 folds compared to a healthy population [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAn earlier systematic review published in 2015 reports that among major chronic diseases, IBD can be predicted in patients with endometriosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another study published in 2019 investigated the association between endometriosis and a comprehensive set of autoimmune diseases and demonstrated an IBD-endometriosis significant association [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study highlighted a significant association between calprotectin levels and endometriosis severity. Patients with severe adhesions showed high calprotectin levels. These findings emphasize the potential role of calprotectin in predicting IBD in patients with endometriosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCD: Crohn\u0026rsquo;s Disease\u003c/p\u003e\n\u003cp\u003eIBD: Inflammatory Bowel Disease\u003c/p\u003e\n\u003cp\u003eIQR: Interquartile Range\u003c/p\u003e\n\u003cp\u003erASRM: American Society of Reproductive Medicine Classification\u003c/p\u003e\n\u003cp\u003eUC: Ulcerative Colitis\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Faculty of Medicine-Alexandria University, Alexandria, Egypt. ethical committee in 2020. The study was conducted according to the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data are available\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests in this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fund was received for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed equally to finalize this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKennedy S, Bergqvist A, Chapron C, D\u0026rsquo;Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20(10):2698\u0026ndash;2704\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGordts S, Koninckx P, Brosens I (2017) Pathogenesis of deep endometriosis. Fertil Steril 108(6):872\u0026ndash;885\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDessole S, Farina M, Rubattu G, Cosmi E, Ambrosini G, Nardelli GB (2003) Sonovaginography is a new technique for assessing rectovaginal endometriosis. Fertil Steril 79(4):1023\u0026ndash;1027\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbraham C, Dulai PS, Vermeire S, Sandborn WJ (2017) Lessons learned from trials targeting cytokine pathways in patients with inflammatory bowel diseases. Gastroenterology 152(2):374\u0026ndash;388\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGajendran M, Loganathan P, Catinella AP, Hashash JG (2018) A comprehensive review and update on Crohn's disease. Dis Mon 64(2):20\u0026ndash;57\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyling RM, Kok K (2018) Fecal calprotectin. Advances in clinical chemistry. ; 87:161\u0026thinsp;\u0026ndash;\u0026thinsp;90\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellini P, Vigan\u0026ograve; P, Somigliana E, Fedele L (2014) Endometriosis: pathogenesis and treatment. Nat Reviews Endocrinol 10(5):261\u0026ndash;275\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarakan T, Karatas A, Cindoruk M, Gulbahar O (2023) P306 Serum tryptophan metabolites as a biomarker for disease severity in patients with IBD. J Crohn's Colitis 17(Supplement1):i450\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJess T, Frisch M, J\u0026oslash;rgensen KT et al (2011) Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut Published Online First: 19 Dec. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/gutjnl-2011-301095\u003c/span\u003e\u003cspan address=\"10.1136/gutjnl-2011-301095\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKvaskoff M, Mu F, Terry KL, Harris HR, Poole EM, Farland L, Missmer SA (2015) Endometriosis: a high-risk population for major chronic diseases? Hum Reprod Update 21(4):500\u0026ndash;516\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShigesi N, Kvaskoff M, Kirtley S, Feng Q, Fang H, Knight JC, Missmer SA, Rahmioglu N, Zondervan KT, Becker CM (2019) The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis. Hum Reprod Update 25(4):486\u0026ndash;503\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJess T, Frisch M, J\u0026oslash;rgensen KT, Pedersen BV, Nielsen NM (2012) Increased risk of inflammatory bowel disease in women with endometriosis: a nationwide Danish cohort study. Gut 61(9):1279\u0026ndash;1283\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable (1): Age distribution of the cases (n = 50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026lt;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e\u0026ge;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e30.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e16.0 \u0026ndash; 40.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e26.50 \u0026plusmn; 5.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 233px;\"\u003e\n \u003cp\u003e26.0 (22.0 \u0026ndash; 31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIQR: Inter quartile range, SD: Standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (2): Distribution of endometriosis cysts and \u0026nbsp;pelvic adhesions \u0026nbsp;among the cases (n = 50)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"695\" height=\"249\"\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e*\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eMinimal\u003c/strong\u003e: if adhesions between one adnexa and ovarian fossa, pelvic wall, or back of the uterus, \u003cstrong\u003eModerate:\u003c/strong\u003e if bilateral adhesions of both adnexa to the lateral pelvic wall or the uterus, \u003cstrong\u003eSevere:\u003c/strong\u003e if kissing ovaries, colonic adhesions, partial or complete obliteration of Douglas pouch.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (3): Calprotectin level among the selected cases (n = 50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMin. \u0026ndash; Max.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalprotectin level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e9.0 \u0026ndash; 70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e24.36 \u0026plusmn; 14.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e20.50 (13.0 \u0026ndash; 34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; IQR: Inter quartile range, SD: Standard deviation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (4): Differences among endometriotic cyst groups and calprotectin levels (n =50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 369px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCyst\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003cbr\u003e\u0026nbsp;(n = 28)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnilateral\u003cbr\u003e\u0026nbsp;(n = 19)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBilateral\u003cbr\u003e\u0026nbsp;(n = 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalprotectin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9.0 \u0026ndash; 48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10.0 \u0026ndash; 70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12.0 \u0026ndash; 22.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e6.158\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.046\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20.46 \u0026plusmn; 11.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e31.05 \u0026plusmn; 16.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18.33 \u0026plusmn; 5.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e17.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e24.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e21.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Hoc test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 497px;\"\u003e\n \u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e=0.015\u003csup\u003e*\u003c/sup\u003e, p\u003csub\u003e2\u003c/sub\u003e=0.967, p\u003csub\u003e3\u003c/sub\u003e=0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn\u0026apos;s test for multiple comparisons) was employed to compare each pair of groups. \u0026nbsp;p1: the p-value obtained from comparing No to Unilateral; p2: the p-value obtained from comparing No to Bilateral; p3: the p-value obtained from comparing Unilateral to Bilateral; *Statistically significant at a p-value \u0026lt; 0.05 \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (5): Differences among levels of adhesions and calprotectin levels (n=50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"648\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 369px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdhesion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMinimal\u003cbr\u003e\u0026nbsp;(n = 23)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModerate\u003cbr\u003e\u0026nbsp;(n = 24)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSevere\u003cbr\u003e\u0026nbsp;(n = 3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalprotectin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10.0 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9.0 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e46.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e42.0 \u003cspan dir=\"RTL\"\u003e\u0026ndash;\u003c/span\u003e70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e7.728\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.021\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20.35\u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e9.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e24.08\u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e12.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e57.33\u003cspan dir=\"RTL\"\u003e\u0026plusmn;\u003c/span\u003e14.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e60.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Hoc Test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 497px;\"\u003e\n \u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e=0.506, p\u003csub\u003e2\u003c/sub\u003e=0.005\u003csup\u003e*\u003c/sup\u003e, p\u003csub\u003e3\u003c/sub\u003e=0.014\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn\u0026apos;s test for multiple comparisons) was employed to compare each pair of groups. p1: p-value representing the comparison between minimal and moderate adhesion; p2: p-value representing the comparison between minimal and severe adhesion; and p3: p-value representing the comparison between moderate and severe adhesion. *High significant difference p \u0026lt; 0.05.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable (6): Differences among rASRM stages and calprotectin levels (n=50)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"649\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 367px;\"\u003e\n \u003cp\u003e\u003cstrong\u003erASRM stage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eH\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eI (n=3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eII (n=36)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIII (n=11)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCalprotectin\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMin. \u0026ndash; Max.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e10.0 \u0026ndash; 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9.0 \u0026ndash; 48.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e12.0 \u0026ndash; 70.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e8.545\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.014\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e11.67 \u0026plusmn; 2.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e22.28 \u0026plusmn; 11.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e34.64 \u0026plusmn; 18.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003eMedian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e11.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePost Hoc Test\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 499px;\"\u003e\n \u003cp\u003ep\u003csub\u003e1\u003c/sub\u003e=0.073, p\u003csub\u003e2\u003c/sub\u003e=0.006\u003csup\u003e*\u003c/sup\u003e, p\u003csub\u003e3\u003c/sub\u003e=0.041\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSD: Standard deviation; H: pairwise comparison wager; Kruskal Wallis test; H: The Post Hoc Test (Dunn\u0026apos;s test for multiple comparisons) was employed to compare each pair of groups; p1: p-value for comparison among I and \u0026nbsp;II; p2: p-value for comparison among I and III; and \u0026nbsp;p3: p-value for comparison among II and III; the Post Hoc Test (Dunn\u0026apos;s for multiple comparisons test) was applied to each of the two groups. *High significant difference p \u0026lt; 0.05.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"middle-east-fertility-society-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mefj","sideBox":"Learn more about [High Temperature Corrosion of Materials](https://www.springer.com/journal/43043)","snPcode":"43043","submissionUrl":"https://submission.nature.com/new-submission/43043/3","title":"Middle East Fertility Society Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pelvic Endometriosis, IBD, Calprotectin","lastPublishedDoi":"10.21203/rs.3.rs-8921054/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8921054/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eEndometriosis is a pathological state distinguished by the endometrial-like tissue\u0026nbsp;located in ectopic regions leading to chronic inflammation, adhesions, and scar tissue potentially distorting a woman's pelvic anatomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo study the association between pelvic endometriosis and Inflammatory Bowel Disease(IBD) using fecal calprotectin analysis in cases diagnosed by laparoscope.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis cross-sectional study was conducted on 50 patients of reproductive age who have symptoms like diarrhea, constipation, or change in bowel habits, symptoms of dysmenorrhea, dysuria, or dyschezia, and all cases were subjected to laparoscopy and diagnosed as pelvic endometriosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe fecal calprotectin level varied from 9.0 – 70.0 μg/g with a mean level of 24.36 ± 14.07 μg/g. For correlating calprotectin level and endometriotic cyst, the studied group was stratified according to the localization of cysts. There was a significant statistical correlation between calprotectin level and endometriotic cyst among the studied 1\u003csup\u003est\u003c/sup\u003e(one cyst) and 2\u003csup\u003end\u003c/sup\u003e group (2 cysts, P=0.015).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eCalprotectin levels were significantly associated with endometriosis severity. Moreover, severe endometriosis adhesions increased calprotectin levels. These findings point up the IBD-endometriosis possible association.\u003c/p\u003e","manuscriptTitle":"Association Between Pelvic Endometriosis and Inflammatory Bowel Disease in Females in Reproductive Age: Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-17 12:49:02","doi":"10.21203/rs.3.rs-8921054/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T06:01:50+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"205077193367865041116264021417875978729","date":"2026-03-18T04:37:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T21:04:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"246638213195596384640779681623615153997","date":"2026-03-15T17:23:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-15T10:59:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270822402859057995439089541390832695338","date":"2026-03-15T10:51:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-14T17:20:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-13T13:24:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"105229866459044194954192999160637779251","date":"2026-03-11T12:14:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58162793088039683453603870635788202582","date":"2026-03-10T19:40:38+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T17:02:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"102185014207593892903068746222167489158","date":"2026-03-10T16:51:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"57435694633346586261324823856292563821","date":"2026-03-10T07:31:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"328405385085966153053280012999387176425","date":"2026-03-10T07:04:59+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-10T07:00:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-28T11:43:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-25T14:42:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"Middle East Fertility Society Journal","date":"2026-02-19T21:59:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"middle-east-fertility-society-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"mefj","sideBox":"Learn more about [High Temperature Corrosion of Materials](https://www.springer.com/journal/43043)","snPcode":"43043","submissionUrl":"https://submission.nature.com/new-submission/43043/3","title":"Middle East Fertility Society Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f7ee3289-fd64-4b22-8a4f-d2ca74061985","owner":[],"postedDate":"March 17th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T06:09:48+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-17 12:49:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8921054","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8921054","identity":"rs-8921054","version":["v1"]},"buildId":"0SHbDDIpRTBOrFPTvp6pu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}