Introduction

The relationship between obesity and inflammatory bowel disease (IBD) is currently undefined. The clinical outcome of obese and non-obese IBD patients is apparently comparable. However, evidences at this regard are conflictual.

Aims & Methods

Primary aim was to compare, in a prospective study, IBD characteristics between overweight or obese and non-obese consecutive IBD patients. Secondary aim was to compare the frequency of immunomodulator therapies, IBD-related surgery and hospitalizations between overweight or obese and non-obese patients.
In a prospective, single-center study, consecutive IBD patients undergoing scheduled outpatients visit between September 2022 and January 2023 were enrolled. Demoghaphic and clinical data including body mass index (BMI) were recorded. Inclusion criteria: 1)defined diagnosis of IBD; 2)age ≥18 years; 3)regular follow up (≥2 visits/year). Exclusion criteria: 1)BMI <18.5 mk/m², 2)incomplete data. Data were expressed as median [range]. Normal distribution of continuous variables tested by the Kolmogonov-Smirnov test. Comparisons assessed by Student-t test, Mann-Whitney u-test and Chi-squared test.

Results

Out of 300 IBD patients assessed, 284 were enrolled (141 [49.6%] Crohn’s Disease (CD); 143 [50.4%] UC). The median age of IBD group was 51 [20-87] and male gender was observed in 157 (55.3%) patients. The median IBD duration was 13.5 [1-57] years. Overall, 170 (59.8%) IBD patients were normal-weight and 114 (40.2%) were overweight or obese.
Among the 141 CD patients enrolled, 89 (63.1%) normal-weight patients and 52 (36.9%) overweight or obese patients were observed. Lesions distribution and behavior was comparable between normal-weight and overweight or obese patients (L1: 62 [70%] vs 35 [67.3%], p=0.77; L2: 8 [9%] vs 4 [7.7%], p=0.79; L3: 19 [21%] vs 13 [25%], p=0.61; L4: 7 [7.9%] vs 2 [3.8%], p=0.34; B1: 24 [27%] vs 13 [25%], p=0.79; B2: 44 [49.4%] vs 32 [61.5%], p=0.16; B3: 21 [23.6%] vs 7 [13.5%], p=0.74, respectively). Perianal disease was more frequently observed in overweight or obese vs normal-weight patients (9 [10.1%] vs 12 [23%], p=0.03). Immunosuppressive (ISS) or biologic use was comparable between groups (ISS: 33 [37%] vs 19 [36.5%], p=0.94; biologics: 23 [25.8%] vs 17 [32.7%], p=0.38). Lack of response to biologics was more frequently observed in overweight and obese vs normal-weight patients (0 [0%] vs 4 [23.4%], p=0.01). Loss of response and adverse events were comparable between groups (11 [47.8%] vs 5 [29.4%], p=0.23; 13 [56.5] vs 8 [47.1%], p=0.55).
Among the 143 UC patients enrolled, 81 (56.6%) normal-weight patients and 62 (63.4%) overweight or obese patients were observed. Proctitis and extensive UC were more frequently reported in overweight or obese vs normal-weight patients (E1: 18 [29%] vs 11 [13.6%], p=0.02; E3: 35 [56.4%] vs 31 [38.3%], p=0.03). Left-sided UC were more frequent in normal-weight then in overweight or obese patients (E2: 39 [48.1%] vs 19 [30.6%], p=0.03). ISS use was comparable between groups (14 [17.3%] vs 7 [11.3%], p=0.31) while biologics were more frequent in normal-weight then in overweight or obese patients (15 [18.5%] vs 4 [6.4%], p=0.03). Lack of response, loss of response and adverse events were comparable between groups (6 [40%] vs 1 [25%], p=0.58; 5 [33.3%] vs 1 [25%], p=0.75; 6 [40%] vs 0 [0%], p=0.12).

Conclusion

In the tested population, overweight or obese CD patients showed a higher frequency of perianal disease and refractoriness to biologics than normal weight patients. These preliminary findings in CD suggest that BMI and phenotype may influence responsiveness to biologics.

Introduction

The clinical course after surgery in Crohn’s Disease (CD) patients ileo-colonic anastomosis (ICA) is well known. Differently, clinical outcome in patients with entero-enteric anastomosis (EEA) after isolated small bowel resection is undefined.

Aims & Methods

The primary aim of the present case-control study was to search for differences in terms of major clinical outcomes at 5 years between CD patients with EEA (Cases), when compared to CD patients with ICA (Controls) matched for age and smoking status before index surgery. Secondary aim was to compare the characteristics of CD and the disease course before index surgery in Cases versus Controls.
All CD patients with EEA were retrospectively enrolled and matched for age at diagnosis (+/- 5 years) and smoking status before index surgery with 2 CD Controls with ICA. Inclusion criteria: 1) age ≥18; 2) EEA or ICA for CD; 3) ≥5-years follow-up after index surgery. Exclusion criteria: 1) missing data; 2) ostomy; 3) stricturoplasty. Data were expressed as median [range]. The Student-t-test, X2 test, Kaplan-Meier curves and logistic regression analyses were used as appropriate.

Results

Cases included 51 CD patients with EEA (ileum-ileum 39 [76.5%], jejunum-ileum 6 [11.8%], jejunum-jejunum 5 [9.8%], duodenum-jejunum 1 [1.9%]). Matched Controls included 102 CD patients with ICA. At 3 and 5 years after surgery, clinical recurrence was more frequent in Cases (28 [54.9%] vs. 37 [36.3%], p=0.04; 34 [66.7%] vs. 43 [42.2%], p=0.007). Cases showed a higher frequency of CD-related hospitalization ≤5 years after surgery (25 [49%] vs. 23 [22.5%], p=0.001]) (Table). In Cases, corticosteroids use was more frequent at 1, 3 and 5 years (14 [27.5%] vs. 8 [7.8%], p=0.002; 21 [41.2%] vs. 15 [14.7%], p=0.0006; 26 [50.9%] vs. 18 [17.6%], p<0.0001) (Table). ISS and biologics use 3 and 5 years after surgery was more frequent in Cases (20 [39.2%] vs. 20 [19.6%], p=0.01; 21 [41.2%] vs. 24 [23.5%], p=0.03; (15 [29.4%] vs. 13 [12.7%], p=0.02 and 23 [45.1%] vs. 15 [14.7%], p=0.03) (Table). Cases showed a shorter time to survival from clinical recurrence and hospitalization (2.36 [1.29-4.35], p=0.0036; 1.71 [1.06-2.77], p=0.02). EEA and ISS use before index surgery were risk factors for CD-related hospitalization and clinical recurrence at 5 years (2.68 [1.11-6.45]; p=0.02, 2.61 [1.21-5.6]; p=0.01 and 2.53 [1.05-6.09]; p=0.03; 2.44 [1.18-5]; p=0.01).

Conclusion

The clinical outcome after surgery is more severe in CD patients with EEA versus ICA, being associated with a higher rate of clinical recurrence, hospitalization and need of major treatments for the disease. This suggests the need of a tight assessment after isolated small bowel surgery, in order to achieve a timely and appropriate treatment and possible prevention of complications.

References

1) Onali S, Petruzziello C, Calabrese E, Condino G, Zorzi F, Sica GS, Pallone F, Biancone L. Frequency, pattern, and risk factors of postoperative recurrence of Crohn's disease after resection different from ileo-colonic. J Gastrointest Surg. 2009; 13 (2): 246-252.
2) Bemelman WA, Warusavitarne J, Sampietro GM, Serclova Z, Zmora O, Luglio G, de Buck van Overstraeten A, Burke JP, Buskens CJ, Francesco C, et al. ECCO-ESCP Consensus on Surgery for Crohn’s Disease. J. Crohns Colitis. 2017; 12: 1-16.

Introduction

Inflammatory bowel disease (IBD) and endometriosis are immuno-mediated chronic inflammatory diseases observed in young women, sharing some of the clinical manifestations (i.e. abdominal pain). The possible association and the relationship between endometriosis and IBD is undefined.

Aims & Methods

In a multidisciplinary approach, we aimed to assess in patients with IBD and concomitant endometriosis, the clinical outcome in terms of abdominal pain and endometriosis-related symptoms at 6 and 12 months and characteristics of endometriosis. All female IBD pts in childbearing age referring symptoms compatible with endometriosis were enrolled and referred to dedicated gynecologists for transvaginal ultrasonography (TVS). Inclusion criteria: 1) female gender; 2) age ≥18 and ≤55 years; 3)well-defined diagnosis of IBD; 4) symptoms compatible with endometriosis; 6) consent. Exclusion criteria: 1) pregnancy; 2) menopause; 3) suspected pelvic malignancy at TVS. Characteristics of IBD, endometriosis and adenomyosis were classified according to standard criteria. Data were expressed as median [range]. The Student-t Test and χ2 test were used for comparisons.

Results

Endometriosis was diagnosed in 25 (71%) out of 35 IBD patients with compatible symptoms. These 25 IBD pts included 12 (48%) Crohn’s Disease (CD) and 13 (52%) Ulcerative Colitis (UC). CD and UC patients were comparable in terms of age (38 [28-47] vs 39 [25-53]; p=0.75). IBD characteristics included: IBD duration: 11.5 [1-35], CD 11 [1-25] vs UC 12 [1-35] years; p=0.8, CD localization: ileum 4 (33.3%), colon 1 (8.4%), ileum-colon 7 (58.3%), CD behavior: non-stricturing non-penetrating 6 (50%), stricturing in 3 (25%), penetrating in 3 (25%) pts, UC extent: proctitis 3 (23%), left-sided 5 (38.5%), pancolitis in 5 (38.5%) pts. Other IBD characteristics did not differ between CD and UC pts with endometriosis. In IBD patients with endometriosis, a comparable frequency of dysmenorrhea (9 [75%] vs 13 [100%] pts; p=0.47), dyschezia (5 [41.7%] vs 6 [46.1%] pts; p=0.85), dyspareunia (9 [75%] vs 10 [76.9%] pts; p=0.72), dysuria (0 [0%] vs 3 [23.1%] pts; p=0.24) was observed between CD and UC. At transvaginal ultrasonography, deep infiltrating endometriosis was observed in all thr 25 patients with IBD and endometriosis. Moreover, a high frequency of rectal endometriosis was detected in these 25 IBD pts (6 [24%]). Adenomyosis was observed in 19 (76%) IBD pts with endometriosis, with no differences between CD and UC (8 [66.6%] vs 11 [84.6%]; p=0.56).
Among the 25 IBD pts with endometriosis, 10 (40%) underwent dienogest or estroprogestinic treatment. At 6 months, gynecological follow up was available in 9 pts, of whom 7 were on dienogest or estroprogestinic treatment. Among these 7 pts, 4 reported no endometriosis-related symptoms and 5 no abdominal pain. At 12 months, gynecological clinical follow-up currently includes 6 pts (25%), all on progestinic treatment. Of these, only 2 pts reported abdominal pain while 3 pts reported recurrence of endometriosis-related symptoms.

Conclusion

In the tested population, endometriosis was present in half of IBD pts with compatible symptoms, particularly DIE, with a high rate of rectal endometriosis. After endometriosis treatment, a lower proportion of patients referred abdominal pain. Endometriosis, often mimicking IBD, should be searched and treated in IBD young patients in order to avoid ineffective treatments.

Introduction

Whether using immunomodulators (IMM) or biologics after a first cancer in Inflammatory Bowel Disease patients (pts) may increase the risk of new or recurrent cancer is undefined.

Aims & Methods

The primary aim was to assess the frequency of new or recurrent cancer in IBD pts treated with IMM or biologics after a previous diagnosis of cancer. The secondary aim was to evaluate the cancer-related mortality in IBD pts treated with IMM and biologics after the first cancer. In a retrospective, multicentre study, clinical records of all IBD pts treated with IMM or biologics after a previous diagnosis of cancer were reviewed. Inclusion criteria:1) Diagnosis of Crohn’s Disease (CD) or Ulcerative Colitis (UC); 2)Cancer history;3)IMM or biologics used after a first cancer;4)IBD and cancer data recorded; 5)Follow-up after cancer ≥4 months (mos). Exclusion criteria:1) IMM used for ≤3 mos. Data considered: IBD features,cancer type,IBD duration, age at diagnosis of cancer, follow-up after cancer,cancer-related death.Data expressed as median [range].

Results

75 IBD pts (57 CD,18 UC) treated with IMM or biologics after a first diagnosis of cancer were enrolled (n [%]: F 36 [48%];age 61 [26-89] yrs).CD features included (n=):L1 (37);L2 (2);L3 (16);L4 (8);B1 (17);B2 (30);B3 (10).UC extent included: E1 (2),E2 (8), E3 (8). Cancer in IBD pts treated with IMM/biologics included (n [%]):basal cell carcinoma (BCC) 14 (18.4%), breast 9 (12%),colorectal 9 (12%),melanoma 8 (10.7%),prostatic or testicular 7 (9.3%), urinary tract 7 (9.3%),thyroid 6 (8%),squamous cell carcinoma (SCC) 4 (5.3%),endometrial 2 (2.7%),hematopoietic 4 (5.3%),others 7 (9.3%).In 2 (2.7%) pts, ≥2 cancers occurred. The median time interval between index cancer and ISS/biologics use was 38 mos [0-428]. IMM after cancer were used for a median of 32.5 [4-131] mos, including: methotrexate (MTX) in 13 (17.3%),thiopurines in 8 (10.7%),mycophenolate mofetil,tacrolimus or everolimus in 3 (4%) pts.Biologics were used after cancer for a median of 36 [3-194] mos:Ustekinumab (UST) in 24 (32%),Vedolizumab (VDZ) in 31 (41.3%),Adalimumab (ADA) in 17 (22.7%), Infliximab (IFX) in 12 (16%),Tofacitinib (Tofa) in 2 (2.7%),Golimumab in 1 (1.3%) pt. Both IMM and biologics were used after a first cancer in 15 (20%),while ≥2 biologics in 16 (%) pts.In a median follow up of 95 [4-509] mos after the first cancer, 8 (10.7%) IBD pts developed a new and/or recurrent cancer after IMM/biologics use.In particular, cancer recurred in 3 (4%) pts (1 melanoma,1 prostatic,1 colonic adenocarcinoma), while new cases of cancer occurred in 6 (8%) pts,all 6 represented by non-melanoma skin cancer (NMSC) (both recurrent and new cancer in 1 pt).A not significant trend for a higher frequency of new vs recurrent cancer (p=0.47) was observed.No cancer-related death were observed.

New and recurrent cancers after IMM/biologics

Conclusion

In a retrospective multicentre study, a low frequency of recurrent cancer was observed in IBD pts using IMM or biologics after the first cancer. A not significant trend for a higher frequency of new vs recurrent cancer (p=0.47) was observed, being almost all new cancers represented by NMSC.

Introduction

Inflammatory bowel disease (IBD) and endometriosis are immuno-mediated chronic inflammatory conditions, with possible shared clinical manifestations (i.e. abdominal pain). The association between IBD and endometriosis is undefined.

Aims & Methods

In a multidisciplinary prospective study, the primary end point was to search and characterize endometriosis in IBD patients (pts) assessed for compatible symptoms. Secondary end point was to identify risk factors for endometriosis among symptoms more frequently associated with this condition in IBD. Characteristics of endometriosis were also compared between Crohn’s Disease (CD) and Ulcerative Colitis (UC).
In a prospective study, all female IBD pts fulfilled a questionnaire to sear for symptoms compatible with endometriosis (dysmenorrhea, dyschezia, dyspareunia, dysuria, heavy menstrual bleeding, HMB). Gynecological evaluation and transvaginal ultrasonography (TVUS) were performed by referral dedicated gynecologist in eligible pts. Inclusion criteria: 1) female gender; 2) age ≥18 and ≤55 years (yrs); 3) well-defined diagnosis of IBD; 4) ≥1 symptom compatible with endometriosis; 5) written informed consent. Exclusion criteria:1) pregnancy; 2) menopause. Characteristics of endometriosis and adenomyosis were reported according to standard classifications. Data were expressed as median [range], difference assessed by chi-square test, Student-t-test and Mann-Whitney U-test, risk factors for endometriosis were searched by uni- and multivariate logistic regression analysis.

Results

The study population included 82 IBD pts with symptoms compatible with endometriosis (dysmenorrhea in 71 [86.5%], dyschezia in 27 [32.92%], dyspareunia in 49 [59.75%], dysuria in 4 [4.87%], HMB in 48 [58.53%]). In IBD group (age 38 [17-53] yrs, BMI 21.8 [17.3-41.6]) there were 41 (50%) pts with CD, 41 (50%) with UC. Among the 82 IBD pts, TVUS detected endometriosis in 51 (62.1%). Among the 51 IBD pts with endometriosis detected by TVUS, there were 21 (41.17%) CD and 30 (58.8%) UC. Deep infiltrating endometriosis (DIE) was diagnosed in 46 (90.19%) IBD pts. Dysmenorrhea, dyspareunia and HMB were more frequent in IBD pts with vs without endometriosis (48 [94.11%] vs 23 [74.1%]; p=0.025; 36 [70.58%] vs 13 [41.93%]; p=0.019, 35 [68.62%] vs 13 [41.93%]; p=0.03 respectively). Differently, the other tested symptoms were comparable between IBD pts with vs without endometriosis: dyschezia (17 [33.33%] vs 10 [32.5%]; p=0.88), dysuria (3 [5.88%] vs 1 [3.22%]; p=0.9). When comparing characteristics of endometriosis in IBD, a higher frequency of endometriosis involving the uterosacral ligament was detected in UC vs CD (27 [90%] vs 8 [38.09%]; p=0.0002). After univariate and multivariate analysis, dysmenorrhea and HMB were indentified as significant risk factors for endometriosis (4.42 [1.01-20.41], p=0.04 and 3.66 [1.33-10.1], p=0.01, respectively).

Conclusion

Endometriosis may be highly underestimated in IBD, being mostly represented by DIE, requiring an expert evaluation for the diagnosis. Dysmenorrhea and HMB, identified as significant risk factors for endometriosis, should be carefully searched in young fertile IBD patients for a timely diagnosis and treatment.

Introduction

In Crohn’s Disease (CD),the natural history of post-operative recurrence (POR) after ileo-colonic (IC) anastomosis has been extensively investigated. Fewer evidences are available regarding the POR after other surgical resections for CD.

Aims & Methods

The primary aim was to investigate, in a retrospective study, the clinical outcome at 5 years (yrs) of patients (pts) with previous CD-related resection different from IC anastomosis. Secondary aim was to assess possible differences in terms of clinical outcome at 5-yrs between pts with small bowel anastomoses involving or not the colon. Data from all pts with CD-related resection different from IC anastomosis from Jan. 2002-Apr. 2018, were recorded.Inclusion criteria:1)age ≥18 yrs; 2)well-defined diagnosis of CD (Montreal)(1);3)history of CD-related bowel resection (index surgery);4) Available data 5-yrs after surgery.Exclusion criteria:1)IC resection; 2)ostomy; 3) strictureplasty. Parameters considered after surgery: need of corticosteroids (CS),biologics, immunomodulators (IMM),CD-related surgery, hospitalization. Data were expressed as median [range], Student-t-test or X² test to assess differences.

Results

The study population included 47 pts with CD-related surgery with anastomosis different from IC (females:18 [38.3%];age:50 [29-78] yrs; CD duration:26 [7-53] yrs; age at surgery:34 [14-63] yrs). CD characteristics A1 n=8 (17%), A2 n=34 (72.3%), A3 n=5 (10.6%) pts; L1 n=23 (48.9%), L2 n=5 (10.6%), L3 n=19 (40.4%); L4 n=14 (29.8%); B1 n=1 (2.1%), B2 n=25 (53.2%), B3 n=21 (44.7%), perianal disease in 5 (10.6%) pts. Time interval between CD diagnosis and index surgery: 8 [0-25] yrs.Surgical indication:penetrating CD in 15 (31.9%), occlusion in 27 (57.4%), perforation in 4 (8.5%), refractory CD in 1 (2.1%) pt. Surgical anastomoses were: ileo-ileal in 23 (48.9%), jejunum-ileal in 5 (10.6%) duodenum-jejunal in 1 (2.1%), jejunum-jejunal in 4 (8.5%), ileo-rectal in 9 (19.1%), colo-colonic in 5 (10.6%) pts. Anastomoses involved only the small bowel in 33 (70.2%) pts, while anastomoses involved also the colon-rectum (ileo-rectal or colo-colonic) in 14 (29.8%) pts. Clinical outcome after index surgery in the 47 pts (at 1-yr and 5-yrs, respectively): A) Additional CD-related surgery in 2 (4.4%) and in 6 (12.8%) pts; B) Clinical recurrence in 16 (34%) and in 34 (72.3%) pts; C) CD-related hospitalization in 7 (14.9%) and in 25 (53.2%) pts. Either CS or IMM were used in 11 (23.4%) pts at 1 yr and in 20 (42.5%) pts at 5 yrs, while biologics in 8 (17%) pts at 1-yr and in 29 (61.7%) at 5 yrs. When comparing pts with anastomoses involving only the small bowel or also the colon-rectum, a comparable clinical outcome was observed, including: additional CD-related surgery (at 1 yr: 1 [3%] vs 1 [7.1%]; p=0.87; at 5-yrs: 4 [12.1%] vs 2 [14.3%]; p=0.78), clinical recurrence (at 1 yr: 10 [30.3%] vs 6 [42.8%]; p=0.62; 5-yrs: 24 [72.7%] vs 11 [78.6%]; p=0.94), CD-related hospitalization (at 1-yr: 4 [8.5%] vs 3 [21.4%], p=0.71; at 5-yrs: 20 [60.6%] vs 6 [42.8%]; p=0.42), need of CS (at 1-yr; 10 [30.3%] vs 2 [14.2%], p=0.43; at 5-yrs:18 [54.5%] vs 5 [35.7%], p=0.38),IMM (at 1 yr:8 [24.2%] vs 2 [14.2%]; p=0.7; at 5 yrs: 17 [51.5%] vs 4 [28.6%]; p=0.26), biologics (at 1 yr: 5 [15.1%] vs 3 [21.4%]; p=0.92); 5 yrs: 21 [63.6%] vs 8 [57.1%]; p=0.92).

Conclusion

In a retrospective study, a severe clinical course characterized CD pts with a history of surgery different from ileo-colonic resection in the previous 5 yrs. Hospitalization or major treatments were required in more than half of cases.

References

1) Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006; 55 (6): 749-753.

Introduction

Inflammatory bowel disease (IBD) and endometriosis are both immuno-mediated chronic inflammatory diseases, sharing some common clinical manifestations (i.e. abdominal pain). A possible association between IBD and endometriosis has been suggested but is currently still undefined.

Aims & Methods

In a multidisciplinary prospective single-center study, we aimed to assess the frequency of undiagnosed endometriosis in IBD patients by searching for symptoms compatible with this condition (dysmenorrhea, dyschezia, dyspareunia, dysuria, heavy menstrual bleeding, HMB). Secondary end point was to compare symptoms compatible with endometriosis in IBD patients with vs without a subsequent diagnosis of endometriosis. In a prospective study, all female IBD patients in childbearing age with symptoms compatible with endometriosis, as revealed by filling a questionnaire during a scheduled visit at our IBD center, were enrolled. After informed consent, gynecological evaluation and transvaginal ultrasonography (TVUS) was performed by our referral dedicated gynecologist, in order to search for pelvic endometriosis. Inclusion criteria: 1) female gender; 2) age ≥18 and ≤50 years; 3) well-defined diagnosis of IBD; 4) ≥1 symptom compatible with endometriosis; 5) written informed consent. Exclusion criteria: 1) pregnancy; 2) menopause. Characteristics of endometriosis and adenomyosis were reported according to standard classifications. Data were expressed as median [range].

Results

The study population included 51 IBD patients (age 37 [23-53] years, body mass index 21.6 [17.3-41.6]). In IBD, there were 24 (47.05%) Crohn’s Disease (CD) and 27 (52.9%) Ulcerative Colitis (UC) patients. At enrollment, questionnaires revealed dysmenorrhea in 43 (84.3%), dyschezia in 18 (35.3%), dyspareunia in 31 (60.8%), dysuria in 4 (7.8%), HMB in 33 (64.7%) patients. At TVUS, endometriosis in any form was observed in 35 (68.6%) IBD patients, adenomyosis in 26 (51%). Both diseases were concomitantly detected in 22 patients (43.1%). In patients showing endometriosis, deep infiltrating endometriosis was diagnosed in 33 (94.3%) IBD patients, and 7 out of these 33 (21.2%) patients showed rectal endometriosis. Among the 35 patients with endometriosis, IBD included CD in 16 (45.7%) and UC in 19 (54.3%). The frequency of the tested 5 symptoms compatible with endometriosis were then compared between IBD patients with vs without a subsequent diagnosis of endometriosis. Dysmenorrhea (32 [91.4%] vs 11 [68.75.4%]; p=0.04) and HMB (26 [74.3.%] vs 7 [43.75%]; p=0.04) were more frequent in IBD patients with endometriosis. Differently, the other considered symptoms were comparable between IBD patients with vs without endometriosis: dyspareunia (24 [68.6%] vs 7 [43.75.%]; p=0.09), dyschezia (11 [31.4%] vs 7 [43.7%]; p=0.39), dysuria (3 [8.6%] vs 1 [6.25%]; p=0.77). No significant differences were observed between UC and CD patients in terms of characteristics of endometriosis, when excluding a higher frequency of endometriosis involving the uterosacral ligament in UC vs CD (16 [84,2%] vs 6 [36.5%]; p=0.005).

Conclusion

Findings from a prospective multidisciplinary study suggest that endometriosis may be highly underestimated in IBD and that specific symptoms, particularly dysmenorrhea and HMB, should be carefully searched in young patients. In IBD, endometriosis was mostly represented by deep infiltrating endometriosis and a higher frequency of rectal endometriosis, potentially leading to rectal bleeding was observed.

References

[1] J. Satsangi, MS Silverberg, S. Vermeire, and J‐F. Colombel. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut 2006; 55(6): 749–753.
[2] American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997;67:817–821.