Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis
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REVIEW
Endometriosis and irritable bowel syndrome: a systematic review and meta‑analysis Francesca Chiaffarino1 · Sonia Cipriani1 · Elena Ricci1 · Paola Agnese Mauri1,2 · Giovanna Esposito2 · Marta Barretta3 · Paolo Vercellini1,2 · Fabio Parazzini1,2 Received: 8 May 2020 / Accepted: 11 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Irritable bowel disease and endometriosis are two common diseases characterized by chronic inflammation state and recurrent abdominal pain. As a consequence of sharing of symptoms and chronic inflammation, endometriosis and IBS may coexist and be misdiagnosed and this leads to delays in diagnosis, mismanagement, and unnecessary testing. In recent years, some studies have found higher risk of IBS in women with endometriosis, compared to women without endometriosis. To provide a general overview, we performed a systematic review and a meta-analysis on published data on this issue. Methods By a systematic literature search selection process, 11 studies were identified for the current study: 2 prospective and 2 retrospective cohort studies, 4 case–control studies, 1 cross-sectional study and 2 clinical series. Results When we meta-analysed data about the prevalence of IBS in women with endometriosis, the overall OR (95%CI), compared to women without endometriosis was 3.26 (1.97–5.39) with no statistically significant heterogeneity. All three studies considering the incidence of IBS in women with a previous diagnosis of endometriosis showed about twofold greater risk among women with endometriosis than women without. Likewise, in the random effects model of the meta-analysis, the overall OR of history of IBS in women with endometriosis was 3.10 (95% CI 2.06–4.67), with no heterogeneity between three studies considered. Conclusion This meta-analysis provides epidemiological evidence of a link between endometriosis and IBS, highlighting two or more times higher risk of IBS in women with endometriosis compared to women without the condition. Keywords Endometriosis · Irritable bowel syndrome · Systematic review · Meta-analysis
Introduction
* Francesca Chiaffarino [email protected]; [email protected] 1
Department of Woman, Newborn and Child, Fondazione Istituto Di Ricovero E Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
2
Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122 Milan, Italy
3
Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Ospedale Macedonio Melloni, Via Macedonio Melloni 52, 20129 Milan, Italy
Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder, characterized mainly by chronic inflammation state and recurrent abdominal pain. Based on 55 studies included in a meta-analysis involving 83,330 women, the pooled IBS prevalence according to f
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