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Differences in intensity and quality of bowel symptoms in patients with colorectal endometriosis

An observational cross-sectional study

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Summary

Background

Patients suffering from colorectal deep endometriosis (DE) experience gastrointestinal symptoms with almost the same frequency as gynecological pain symptoms. Preoperatively existing gastrointestinal symptoms may translate into pathological gastrointestinal quality of life index (GIQLI) and low anterior resection syndrome scores (LARS). This prospective questionnaire-based case control study aims to assess the prevalence of gastrointestinal complaints reflected by changes in LARS and GIQLI scores in patients with colorectal deep endometriosis prior to surgical treatment and compare those to a healthy control group.

Methods

The study was conducted at the Hospital St. John of God in Vienna and included a total of 97 patients with histologically confirmed colorectal DE with radical surgical treatment and 96 women in whom DE was excluded via transvaginal sonography (TVS) or visually. Gastrointestinal symptoms reflected by LARS and GIQLI scores were evaluated presurgically and in controls.

Results

A total of 193 premenopausal patients were included in this study. A mean GIQLI of 90.7 ± 22.0 and 129.4 ± 11.1 was observed among patients and controls, respectively, showing a significantly higher morbidity concerning gastrointestinal symptoms and decreased quality of life (QoL) compared to healthy controls (p < 0.001). The LARS score results demonstrated that 18.6% of the patients with bowel DE presented with a major LARS and 27.8% with a minor LARS presurgically compared to 2.1% and 9.4% of control patients, respectively (p < 0.001).

Conclusion

Patients with colorectal DE experience a quality of gastrointestinal symptoms translating into a decreased QoL and pathological GIQLI and LARS scores already presurgically. As a consequence, these instruments should be interpreted with caution.

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Acknowledgements

The authors thank Ayman Tammaa MD, Alexander Krell MD and Friedrich Reh MD for their assistance leading to the writing of this paper during the patient recruitment phase of the current study.

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Authors and Affiliations

  1. Department of Gynecology, Center for Endometriosis, Hospital St. John of God, Vienna, Austria

    Lena Maria Reh MD, Eliana Montanari MD, PhD & Gernot Hudelist MD, MSc

  2. Brussels IVF, Centre for Reproductive Medicine Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Av. du Laerbeek 101, 1090, Jette, Belgium

    Ezgi Darici MD

  3. Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

    Eliana Montanari MD, PhD

  4. Practice Drs. Keckstein, Villach, Austria

    Joerg Keckstein MD

  5. Freelance psychologist, Vienna, Austria

    Birgit Senft PhD

  6. Department of General Surgery, Center for Endometriosis, Hospital St. John of God, Vienna, Austria

    Bernhard Dauser MD, MBA

  7. Stiftung Endometrioseforschung SEF, Westerstede, Germany

    Joerg Keckstein MD & Gernot Hudelist MD, MSc

Authors
  1. Lena Maria Reh MD
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  2. Ezgi Darici MD
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  6. Bernhard Dauser MD, MBA
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  7. Gernot Hudelist MD, MSc
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Contributions

L. M. Reh: study design, execution and analysis, manuscript writing; E. Darici: study design, execution and analysis; E. Montanari: study design, execution and analysis; B. Senft: statistical analysis; J. Keckstein: study design, manuscript writing; B. Dauser: study design, manuscript writing; G. Hudelist: study design, manuscript writing. All authors approved the final manuscript.

Corresponding author

Correspondence to Ezgi Darici MD.

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Conflict of interest

L. M. Reh, E. Darici, E. Montanari, J. Keckstein, B. Senft, B. Dauser, and G. Hudelist declare that they have no competing interests.

Ethical approval

The study was approved on 17 November 2020 by the ethics committee/IRB of the Hospital St. John of God in Vienna, Austria.

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Lena Maria Reh and Ezgi Darici contributed equally to this work.

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Reh, L.M., Darici, E., Montanari, E. et al. Differences in intensity and quality of bowel symptoms in patients with colorectal endometriosis. Wien Klin Wochenschr 134, 772–778 (2022). https://doi.org/10.1007/s00508-022-02088-x

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  • DOI: https://doi.org/10.1007/s00508-022-02088-x

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