痛经：子宫内膜异位症及其与慢性炎症性肠病（IBD）重叠的关键症状

IF 3.3 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Journal of minimally invasive gynecology Pub Date : 2025-10-22 DOI:10.1016/j.jmig.2025.09.028

C Exacoustos , F Iacobini , G Monaco , M Fiorillo , B Neri , L Biancone , C Russo

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引用次数: 0

摘要

研究目的通过多学科方法评估伴有相关症状的IBD患者盆腔子宫内膜异位症的存在、类型和位置，并比较溃疡性结肠炎（UC）和克罗恩病（CD）患者子宫内膜异位症的定位。前瞻性观察性研究。背景：意大利大学医院二级妇科超声科及子宫内膜异位症中心。患者或参与者：从2020年到2024年连续纳入82例患者。干预措施：我们纳入82例绝经前伴有子宫内膜异位症症状（如痛经、性交困难、月经困难、排尿困难、HMB）的IBD患者，并转介经阴道超声（TVS）评估。记录子宫内膜异位症的存在、类型和部位。排除无特定症状的IBD患者。对照组为无IBD的子宫内膜异位症患者，年龄（±5岁）和BMI（±1 kg/m²）比例为1:4。测量和初步结果51/82 (62.2%)IBD患者有子宫内膜异位症，其中30（58.8%）有UC， 21（41.2%）有CD。在我们的IBD人群中，71/82（86.6%）患者有痛经。与没有痛经的女性相比，这些女性患有子宫内膜异位症的比例更高（67.6%对27.3%,p=0.01）。伴有子宫内膜异位症的IBD患者痛经、性交困难和HMB发生率明显高于无子宫内膜异位症的IBD患者（94.1%比74.2%,p=0.01； 68.6%比41.9%,p=0.01； 68.6%比41.9%,p=0.01）。特别是UC患者的侧侧死亡明显高于CD患者（86.7% vs 42.9%, p=0.001），而CD患者的后部死亡明显高于UC患者（57.1% vs 26.7%, p=0.03）。与对照组、子宫内膜异位症但无IBD患者相比，IBD合并子宫内膜异位症患者的死亡发生率更高（90.2% vs 77.5% p=0.04），而子宫内膜异位症患者的死亡发生率更高（43.1% vs 27.5% p=0.04）。结论子宫内膜异位症在IBD伴发症状患者中较为常见，痛经发生率较高。TVS可以帮助鉴别子宫内膜异位症并改善治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Dysmenorrhea: A Key Symptom in Endometriosis and Its Overlap with Chronic Inflammatory Bowel Diseases (IBD)

Study Objective

To assess, through a multidisciplinary approach, the presence, type, and location of pelvic endometriosis in IBD patients with related symptoms, and to compare endometriosis localizations between ulcerative colitis (UC) and Crohn’s disease (CD).

Design

Prospective observational study.

Setting

Second-level gynecological ultrasound Unit and Endometriosis Center in Italy, University Hospital.

Patients or Participants

Eighty-two consecutive patients included from 2020 to 2024.

Interventions

We included 82 premenopausal IBD patients with symptoms suggestive of endometriosis (e.g., dysmenorrhea, dyspareunia, dyschezia, dysuria, HMB), referred for transvaginal ultrasound (TVS) assessment. Endometriosis presence, type, and site were recorded. IBD patients without specific symptoms were excluded. Controls were endometriosis patients without IBD, matched 1:4 by age (±5 years) and BMI (±1 kg/m²).

Measurements and Primary Results

Endometriosis was detected in 51/82 (62.2 %) IBD patients with compatible symptoms: 30 (58.8%) had UC and 21 (41.2%) had CD. In our IBD population 71/82 (86.6%) patients had dysmenorrhea. These women had a higher percentage of endometriosis compared to women without dysmenorrhea (67.6% vs 27.3%, p=0.01). Dysmenorrhea, dyspareunia and HMB were significantly more frequent in IBD patients with endometriosis compared to IBD patients without endometriosis (94.1% vs 74.2%, p=0.01; 68.6% vs 41.9%, p=0.01; 68.6% vs 41.9%, p=0.01). In particular lateral DIE was significantly more frequent in UC patients compared to CD ones (86.7% vs 42.9%, p=0.001), instead posterior DIE was significantly more frequent in CD patients compared to UC ones (57.1% vs 26.7%, p=0.03). DIE was more frequent in IBD patients with endometriosis compared to the control group, patients with endometriosis but without IBD (90.2% vs 77.5% p=0.04), while endometrioma was more frequent in the control group (43.1% vs 27.5% p=0.04).

Conclusion

Endometriosis was common in patients with IBD and compatible symptoms, with dysmenorrhea frequently reported. TVS can aid in identifying endometriosis and improving management in this group.

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来源期刊

Journal of minimally invasive gynecology 医学-妇产科学

CiteScore

5.00

自引率

7.30%

发文量

272

审稿时长

37 days

期刊介绍： The Journal of Minimally Invasive Gynecology, formerly titled The Journal of the American Association of Gynecologic Laparoscopists, is an international clinical forum for the exchange and dissemination of ideas, findings and techniques relevant to gynecologic endoscopy and other minimally invasive procedures. The Journal, which presents research, clinical opinions and case reports from the brightest minds in gynecologic surgery, is an authoritative source informing practicing physicians of the latest, cutting-edge developments occurring in this emerging field.