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Visceral hypersensitivity in endometriosis: a new target for treatment?
  1. B Issa1,
  2. T S Onon2,
  3. A Agrawal1,
  4. C Shekhar1,
  5. J Morris3,
  6. S Hamdy1,
  7. P J Whorwell1
  1. 1Department of Translational Medicine, University of Manchester, Manchester, UK
  2. 2Department of Obstetrics and Gynaecology, University Hospital of South Manchester, Manchester, UK
  3. 3Department of Medical Statistics, University Hospital of South Manchester, Manchester, UK
  1. Correspondence to Professor P J Whorwell, Neurogastroenterology Unit, Wythenshawe Hospital, Manchester M23 9LT, UK; peter.whorwell{at}uhsm.nhs.uk

Abstract

Objective In women presenting to gynaecological clinics with lower abdominal pain, the cause is frequently attributed to endometriosis irrespective of whether it is found to be minimal or extensive at laparoscopy. Irritable bowel syndrome (IBS) is also common in this setting, and it was speculated that the visceral hypersensitivity associated with this condition might be amplifying the symptoms of endometriosis.

Methods Visceral sensitivity to balloon distension, symptoms and psychological status were assessed following laparoscopy in 20 women with minimal to mild endometriosis, 20 with moderate to severe endometriosis, 20 with laparoscopy negative abdominal pain and 20 asymptomatic women undergoing laparoscopic sterilisation who acted as controls, and compared with 20 women with IBS.

Results Compared with controls, patients with minimal to mild and moderate to severe endometriosis had a higher prevalence of symptoms consistent with IBS (0% vs 65% and 50%, respectively, p<0.001) with significantly lower mean pain thresholds (39.5 mm Hg (95% CI 36.0 to 43.0) vs 28.1 mm Hg (95% CI 24.5 to 31.6), p=0.001 and 28.8 mm Hg (95% CI 24.9 to 32.6), p=0.002) not explained by differences in rectal compliance. Patients with laparoscopy negative pain had symptoms and visceral sensitivity similar to patients with IBS. Controls undergoing laparoscopy had normal sensitivity, indicating that the laparoscopic procedure was not inducing hypersensitivity.

Conclusion Visceral hypersensitivity is extremely common in endometriosis and could be intensifying the pain. This finding might explain why mildly affected individuals often complain of severe symptoms out of proportion to the extent of their disease. This study has introduced a completely new concept into the understanding of pain in endometriosis and could open up new opportunities for treatment.

  • Irritable bowel syndrome
  • endometriosis
  • visceral sensitivity
  • neurogastroenterology
  • dysphagia after stroke
  • oesophageal motility
  • anal incontinence
  • nerve-gut interactions
  • oesophageal physiology
  • nervous control of intestinal functions
  • irritable bowel syndrome
  • functional abdominal pain
  • functional bowel disorder
  • functional dyspepsia

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Footnotes

  • Funding PJW has served as an advisory board member or received research funding from the following pharmaceutical companies: Novartis Pharmaceuticals, Glaxo SmithKline, Pfizer Global R&D, Solvay Pharmaceuticals, Rotta Research, Proctor and Gamble, Danone Research, Astellas Pharma, Ironwood Pharmaceuticals, Sucampo Pharmaceuticals, Almirall Pharma, Movetis UK, Norgine and Chr Hansen, Boehringer-Ingelheim, Heel GmbH.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the South Manchester Research Committee and all participants gave written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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