When to suspect endometriosis in IBS: tips for the gastroenterologist

Endometriosis is a common disease affecting up to 10% of women of reproductive age. The sequelae, including pain, subfertility and impact on social well-being, result in a significant economic burden in the UK which is comparable to diabetes. Up to 90% of patients with endometriosis report symptoms that are also observed by the gastroenterologist in women who have irritable bowel syndrome. These include abdominal pain, bloating and altered bowel habit. The two conditions share a number of pathophysiological pathways and are thought to coexist in up to 60%. It is likely that the patients being treated in either clinic have an undertreated comorbidity. Patients continue to experience significant delays in the diagnosis of endometriosis and often see multiple specialities, including gastroenterology, before reaching an endometriosis specialist. While formal diagnosis requires an invasive laparoscopic procedure for biopsy, there are a number of symptoms associated with underlying endometriosis that can be used to identify patients most likely to benefit from surgery. The mainstay of treatment includes surgery or hormonal suppression. Increasing evidence continues to emerge to suggest the benefits of alternative therapies. A key alternative therapy to highlight is the positive impact on symptoms from an anti-inflammatory diet. A low fermentable oligosaccharide, disaccharide and monosaccharide and polyol diet, or exclusion of proinflammatory substances (alcohol, gluten, caffeine, dairy), has been shown to improve gastrointestinal symptoms associated with endometriosis. Raising awareness and education among healthcare professionals, and moving towards multidisciplinary team working aims to reduce time to diagnosis and improve patient outcomes.