Gastrointestinal disorder prevalence among women with endometriosis

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A study in the Journal of Physiology and Pharmacology confirms a strong connection between nutrient intake and gastrointestinal disorders in women with endometriosis. As a result, the German authors believe a dietary intervention by a professional nutritionist may help reduce the disease burden of endometriosis in affected women.

Recent studies indicate that nutrition impacts endometriosis onset and progression. However, because data about the actual nutrient intake of endometriosis patients are sparse, the investigators examined the actual nutrient intake and potential influencing factors in these women.

The retrospective case-control study comprised 156 women with endometriosis and 52 age-matched controls. All study participants completed a validated food frequency questionnaire of their nutrient intake over the past 12 months, along with a disease-related questionnaire to determine disease status, clinical symptoms and comorbidities.

Women with endometriosis suffered significantly more from diet-related comorbidities than the control group, such as for food intolerances (25.6% vs. 7.7%; P = 0.009) and allergies (57% vs. 31%; P < 0.001). Gastrointestinal symptoms, including constipation, flatulence, pyrosis, diarrhea or frequent defecation, were also higher in the endometriosis group (77% vs. 29%; P < 0.001).

In addition, the nutrient intake of patients with endometriosis varied significantly from controls, with a notable lower ingestion of organic acids (P = 0.006), maltose (P = 0.016), glycogen (P = 0.035), tetradecenoic acid (P = 0.041), methionine (P = 0.046), lysine (P = 0.048), threonine (P = 0.046) and histidine (P = 0.049).

Similarly, the total intake of animal proteins was significantly lower among women with endometriosis compared to controls (P = 0.047).

The endometriosis group also showed a decreased intake of vitamin C (P = 0.031), vitamin B₁₂ (P = 0.008) and magnesium (P = 0.043) compared to controls.  The lower intake of vitamin B₁₂ in the endometriosis group could be attributed to a lower intake of animal protein in this group because the vitamin is mostly found in animal products.

The endometriosis group also failed to attain the recommended daily intake of 300 μg folate. About 77% of the women in the endometriosis group said they suffered from gastrointestinal symptoms, namely constipation and flatulence, versus 29% in the control group (P < 0.001).

Besides disease localization, therapeutic treatment like gynecological surgeries and medications may impact gastrointestinal symptoms.

The current study found hysterectomy and ovariectomy impaired indigestion, in particular constipation, flatulence and diarrhea in the endometriosis group. The investigators also observed a significantly higher portion of celiac disease and gluten sensitivity in women with endometriosis compared to controls, “which may explain the positive effect of a gluten-free diet in the management of pelvic pain in these patients.”

Initiating studies to assess the prevalence of food intolerance in relation to endometriosis might help manage pain and gastrointestinal symptoms, such as through dietary interventions. “Considering the described gastrointestinal symptoms and food intolerances, endometriosis patients probably have a different nutritional behavior compared to women without endometriosis,” the authors wrote.