New findings by Cleveland Clinic researchers demonstrate the importance of evaluating gynecologic overlap in women who present with upper gastrointestinal (GI) symptoms such as nausea and gastroparesis. A retrospective chart review published in Clinical Gastroenterology and Hepatology compared gastrointestinal symptoms and health care utilization in women with and without endometriosis.
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Although endometriosis is usually associated with severe menstrual pain and abdominopelvic pain, the majority of women with endometriosis experience gastrointestinal symptoms such as constipation, bloating, diarrhea, and nausea. I also experience Some studies also show that women with endometriosis have a much higher risk of developing irritable bowel syndrome (IBS) than women without endometriosis, with rates as high as 52%. 1 Patients with both endometriosis and IBS report lower pain thresholds and more painful menstrual cycles than other women. Patients who have only one of the symptoms.
“As long as I've worked in gastroenterology, I've noticed that the prevalence of gynecological conditions in my patients has increased,” said Madison Simmons, MD, a gastrointestinal psychologist at the Cleveland Clinic's Digestive Disease Institute and lead author of the paper. “I've come to realize that it's expensive,” he says. “This is something I've been testing for since the beginning of my career, and this study was actually a preliminary study of women with and without endometriosis with gastrointestinal disease and their symptoms. This patient One of the biggest challenges for the population is how long it takes to diagnose, so any insight that allows us to identify and diagnose these patients more quickly would be extremely valuable. I did.”
Research design and findings
The research group reviewed medical records of adult women with endometriosis and compared them with adult women without endometriosis who visited a gastroenterology outpatient clinic at a tertiary care hospital. The final patient sample included 6,736 women seen between 2010 and 2022. Of these, 3,236 were women with endometriosis (GYN) and 3,500 women without endometriosis were included as control subjects (GI). The group analyzes patient demographics, health care utilization (defined as number of outpatient visits, emergency room visits, hospitalizations, phone calls, and abdominal surgeries), and how patients are diagnosed by ICD-10 codes in their medical records at the time of the visit. We evaluated whether the
The study population was 78.2% Caucasian, and the mean age at presentation was 53.8 years. The GYN group was younger (M = 49.5 and 57.8 years; P < .001) and more likely to be non-white (P < .001 for both racial variables). The gynecological group was significantly more likely to have abdominal pain (right upper quadrant, epigastric, generalized), abdominal distension, nausea, changes in bowel habits, iron deficiency anemia, and gastroparesis. However, the gastrointestinal group was significantly more likely to have Crohn's disease and abnormal weight loss.
The researchers also found that the gynecology group had higher rates of health care utilization than the gastroenterology group for most aspects of health care delivery. The gynecology group had fewer outpatient visits but more hospitalizations, phone calls, and abdominal surgeries compared with the control group (all P < .001). The number of emergency department visits for the obstetrics and gynecology group ranged from 0 to 327, while the number of emergency department visits for the GI group ranged from 0 to 88. The range of length of stay was also higher in the GYN group (0–147 patients) than in the GI group (0–66 patients).
“We expected women with multiple conditions to have higher health care utilization,” says Dr. Simmons. “However, we found that women with endometriosis had higher rates of health care utilization almost across the board. But what was most striking about our findings was that women with endometriosis and women without endometriosis had higher rates of health care utilization. It was the type of diagnosis that was seen.”
She continued, “Historically, we have focused on the overlap between endometriosis and lower GI symptoms, but that was not what we saw in this data set. The findings show that these women suffer from upper gastrointestinal disorders such as indigestion and gastroparesis. The main point here is the importance of thorough screening and the location of symptoms for potential gynecological overlap in women presenting with gastrointestinal symptoms. I think it's important to realize that you can't just eliminate it.”
Care at Cleveland Clinic
Dr. Simmons explains that it was important for her and her gastroenterology colleagues to continue to build relationships with Cleveland Clinic gynecologists. She says the strong connections between professional groups have enabled smooth transitions and cooperation between these disciplines.
“Over the past two years, we have seen more gastroenterologists investigating gynecological conditions in patients with gastrointestinal conditions that span the gastrointestinal tract,” says Dr. Simons. “Some gynecologists are getting input from their gastroenterology colleagues early in the process. This allows us to identify these women more quickly, treat them earlier, and improve their quality of life. Asking questions about gynecological symptoms at the front end will speed up diagnosis time and reduce healthcare utilization for this patient population.”
References
Issa B, Onon TS, Agrawal A, et al. Visceral hypersensitivity in endometriosis: a new therapeutic target? Intestines. 2012;61:367–372.
