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Endometriose und Nervenfasern

Ist Endometriose durch den Nachweis von Nervenfasern im Endometrium diagnostizierbar?

Endometriosis and nerve fibers

Can endometriosis be diagnosed by detection of nerve fibers in eutopic endometrium?

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Der Gynäkologe Aims and scope

Zusammenfassung

Nervenfasern konnten im eutopen Endometrium von Patientinnen mit Endometriose sowie in ektopen Endometrioseläsionen nachgewiesen werden. Zwei pathophysiologische Hypothesen werden hinsichtlich des Vorkommens von Nervenfasern sowohl im Endometrium als auch in ektopen Läsionen kontrovers diskutiert: Ist das Vorkommen von Nervenfasern ein rein endometrioseabhängiges oder auch ein schmerzabhängiges Phänomen? Diese Diskussion basiert auf unterschiedlichen Beobachtungen. Einerseits werden Nervenfasern ausschließlich im Endometrium von Patientinnen mit Endometriose beschrieben, unabhängig von deren Beschwerden. Andererseits wurden Nervenfasern im Endometrium von Patientinnen mit Schmerzen gefunden, wie sie auch bei anderen gynäkologischen Erkrankungen wie Myomen auftreten können. Diese Frage hat hohe Klärungsrelevanz, da in diesem Zusammenhang postuliert wurde, dass das Vorkommen von endometrialen Nervenfasern als nichtinvasive Testmethode für das Vorliegen einer Endometriose gewertet werden könnte. Fest steht, dass Endometriose neuromodulierende Eigenschaften aufweist, ob nun endometrioseabhängig oder durch Schmerzfaktoren verursacht. Eine Nerveninvasion in Endometrioseläsionen bietet eine schlüssige Erklärung hinsichtlich der bislang unklaren Pathogenese der mit Endometriose assoziierten Beschwerden.

Abstract

Nerve fibers could be detected in eutopic endometrium of patients with endometriosis and in ectopic endometriotic lesions such as peritoneal, deep infiltrating, and ovarian endometriotic lesions. The pathophysiological explanation for the occurrence of nerve fibers in endometrium and ectopic lesions is controversially discussed. There are two hypotheses: the occurrence of nerve fibers is induced by endometriosis or depends on pain mediators. Nerve fibers are only found in endometrium of patients with endometriosis and their presence is independent of the severity of pelvic pain. On the other hand, nerve fibers are found in endometrium of patients with chronic pelvic pain and with gynecological disorders like fibroids or endometriosis. It has to be clarified if the occurrence of endometrial nerve fibers can be used as a noninvasive test to diagnose endometriosis. However, endometriosis shows neuromodulatory properties. The nerve fiber invasion in endometriotic lesions may be a possible explanation for pain generation in endometriosis.

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Authors and Affiliations

  1. Endometriosezentrum Charité, Klinik für Gynäkologie mit Hochschulambulanz, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    M.L. Barcena de Arellano, A. Fiebitz, J. Arnold, A. Schneider &  S. Mechsner

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  1. M.L. Barcena de Arellano
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  2. A. Fiebitz
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  3. J. Arnold
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  4. A. Schneider
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  5. S. Mechsner
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Correspondence to S. Mechsner.

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Barcena de Arellano, M., Fiebitz, A., Arnold, J. et al. Endometriose und Nervenfasern. Gynäkologe 43, 901–909 (2010). https://doi.org/10.1007/s00129-010-2589-2

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