Background The importance of gut health and microbiome have been emphasized in women’s health. Endometriosis is characterized by abnormal growth of endometrial cells that occurs outside of the uterus (IDDF2021-ABS-0132 Figure 1. Potential association of gut microbiome in endometriosis). Animal models of endometriosis display different gut microbiota compositions compared to healthy controls, and the oral administration of broad-spectrum antibiotics has been shown to reduce disease progression. The current study investigates the relationship between the gut microbiome and endometriosis in humans before exploring potential mechanisms involved.
Methods Searches were performed in three databases (PubMed, Ovid Medline, ScienceDirect; database inception to 31st May 2021 using ‘gut’, ‘microbiome,’ or ‘microbiota’ combined with ‘endometriosis’ following PRISMA guidelines). All titles and abstracts retrieved were screened based on the inclusion and exclusion criteria. Studies reporting gut microbiome data in relation to endometriosis in humans were included in the current analysis but not those without gut microbiome data.
Results Three studies were selected for qualitative analysis according to the inclusion and exclusion criteria. All studies investigated the gut microbiota composition by whole genome sequencing, specifically targeting the 16S rRNA gene. These studies detected significant differences in selected bacterial abundance in the gut microbiome among endometriosis patients and control. Two of them discussed potential bacterial group(s) that correlates with gastrointestinal symptoms in endometriosis patients. A study in 2019 showed that two endometriosis patients had high Escherichia/Shigella in stool, and subsequent follow-up showed severe bowel involvement by endometriosis requiring segmental colon resection. Another team also indicated in their recent work that those with endometrial involvement of the gastrointestinal tract had a higher abundance of Lactococcus (Class Bacilli) compared to those without involvement. The same study noted a non-significant enrichment of Enterobacteriaceae in endometriosis patients that warrants further investigation to evaluate the involvement of gut microbiota in endometriosis.
Conclusions Further studies are required to establish the association and involvement of gut microbiota in endometriosis. The heterogeneity in study design (inclusion/exclusion criteria etc.) increases the difficulty in making a meaningful comparison. More information on diet and antibiotic drug use need to be collected to provide a better overview and insightful analysis of the gut microbiome in endometriosis.
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