P1245 Dyspareunia and heavy menstrual bleeding as risk factors for undiagnosed Endometriosis in patients with Inflammatory Bowel Disease: a multidisciplinary prospective study

Abstract Background Inflammatory bowel disease (IBD) and endometriosis are both chronic inflammatory-mediated conditions, sharing clinical features. The association between IBD and endometriosis remains poorly defined. In a multidisciplinary prospective study, primary aim was to search for risk factors for endometriosis in IBD patients (pts) among symptoms associated with this condition. Secondary endpoint was to compare clinical characteristics in pts with vs without endometriosis. Methods Consecutive female IBD pts in childbearing age with ≥1 symptom compatible with endometriosis (dysmenorrhea, dyschezia, dyspareunia, dysuria, heavy menstrual bleeding, HMB, chronic abdominal pain) were enrolled. Gynecological evaluation and transvaginal ultrasonography (TVUS) were performed by referral dedicated gynecologist to search for pelvic endometriosis. Inclusion criteria: 1) female gender; 2) age ≥18 and ≤55 years; 3) IBD diagnosis; 4) ≥1 symptom compatible with endometriosis; 5) consent. Exclusion criteria: 1) pregnancy; 2) menopause. Data expressed as median [range], differences assessed by X2 test, Student t-test, Mann-Whitney U-test, risk factors for endometriosis using uni- and multivariate logistic regression. Results The study population included 82 IBD pts (age 38 [18-53] years): 41 (50%) Crohn’s Disease (CD) and 41 (50%) Ulcerative Colitis (UC).Dysmenorrhea was reported by 72 (87.8%) pts, dyschezia by 29 (35.4%), dyspareunia by 46 (56.1%), dysuria by 9 (10.9%), HMB by 50 (60.1%) and chronic abdominal pain by 22 (26.8). At TVUS, endometriosis was observed in 51 (62.2%) pts, adenomyosis in 32 (39.1%). In the 51 pts with endometriosis (CD:23 [45.1%], UC:28 [54.9%]), deep infiltrating endometriosis (DIE) was diagnosed in 44 (86.3%). Dyspareunia, HBM and chronic abdominal pain were more frequent in pts with endometriosis (35 [68.6%] vs 11 [35.5%];p=0.007, 36 [70.6%] vs 14 [45.2];p=0.03, 18 [35.3%] vs 4 [12.9%];p=0.04, respectively). The frequency of other symptoms considered were comparable between groups. Posterior DIE was more frequently observed in CD (6 [21.4%] vs 14 [60.9%];p=0.009), while left utero-sacral ligament endometriosis in UC (21 [75%] vs 9 [39.1%];p=0.02). The other endometriosis characteristics were comparable between groups. At uni and multivariate analysis, among the symptoms considered, dyspareunia and HMB were identified as risk factors for endometriosis (4.7 [1.6-13.9];p=0.005; 4.3 [1.4-12.9];p=0.008, respectively). Conclusion Findings from a prospective multidisciplinary study support that endometriosis is highly underestimated in IBD, mostly represented by DIE.Dyspareunia and HMB were confirmed as risk factors for a diagnosis of endometriosis, thus suggesting that these symptoms should be carefully searched in female young IBD patients. References: 1. Neri B, Russo C, Mossa M, et al. High frequency of deep infiltrating endometriosis in patients with inflammatory bowel disease: A nested case-Control study. Digestive Dis. 2023;41(5):719-728. 2. Lee KK, Jharap B, Maser EA, Colombel JF. Impact of concomitant endometriosis on phenotype and natural history of inflammatory bowel disease. Inflamm Bowel Dis 2016;22(1):159-163. 3. Fiorillo, M, Neri B, Mancone R, Russo C, Iacobini F, Schiavone, SC, De Cristofaro E, Migliozzi S, Exacoustos C, Biancone L. Inflammatory Bowel Disease and Endometriosis: Diagnosis and Clinical Characteristics. Biomedicines 2024;12:2521 Conflict of interest: Fiorillo, Mariasofia: No conflict of interest Neri, Benedetto: No conflict of interest Iacobini, Federica: No conflict of interest Mancone, Roberto: No conflict of interest Balice, Raffaele: No conflict of interest Laluci, Eleonora: No conflict of interest Russo, Consuelo: No conflict of interest Exacoustos, Caterina: No conflict of interest Biancone, Livia: No conflict of interest