Endometriosis: A Retrospective Analysis of Clinical Data from a Cohort of 4,083 Patients, With Focus on Symptoms, 2022, Signorile et al

[Andy]

Abstract

Background: Endometriosis is an estrogen-dependent and chronic inflammatory gynecological disease due to the presence of ectopic endometrial tissue outside the uterine cavity. This disease affects approximately 10% of the female population. In spite of its relatively high prevalence, information about its pathogenesis, diagnosis, and therapy is not complete.

Patients and Methods: We present a retrospective study performed on 4,083 patients with endometriosis, with a focus on symptoms. The archived data were analyzed investigating the distribution of symptoms among patients, the correlation of symptoms with the occupation of the patients, and finally the correlation with the other anamnestic data. Statistical associations between the data for all cases were then considered separately.

Results: Chronic fatigue syndrome and dyspareunia were confirmed as being among the main symptoms of endometriosis, together with bowel disorders. On the other hand, we registered a low occurrence of urinary disorders and even of chronic pelvic pain, which is usually considered among the main symptoms of endometriosis. We found an increase in incidence of symptoms starting from the age group 25-29 years up to 40-44 years and, subsequently, a significant decrease in the group aged 55-59 years. For all the symptoms analyzed, we found a higher incidence in employers, graduates and freelancers. Finally, we found a protective effect of the number of gestations on chronic fatigue syndrome.

Conclusion: This in-depth study on such a vast cohort of affected patients clarifies some important aspects on the complex symptomatology of this still enigmatic disease. In particular, the study highlights the symptoms most closely related to endometriosis which will help speed up the diagnostic process of patients suffering from this pathology.

Open access, https://iv.iiarjournals.org/content/36/2/874

 

[Andy]

They seem to be equating asthenia (Wikipedia: "a condition in which the body lacks strength or has lost strength, either as a whole or in any of its parts". It also looks like it get applies to "energy" as well.) to chronic fatigue syndrome i.e. chronic fatigue.

 

[Jonathan Edwards]

This in-depth study on such a vast cohort of affected patients clarifies some important aspects on the complex symptomatology of this still enigmatic disease.

No it doesn't, because you have done the study back to front.

To clarify things you need to do a population cohort study with blinded objective testing for pathology is gold standard.

This looks like an extreme version of the concerns I have had about DecodeME - which I now think for DecodeME are probably not too serious. But here ...

 

[Hutan]

My reaction to the abstract was similar - it looked like a diagnostic mess. But the paper suggests that they did make an effort to objectively diagnose endometriosis. e.g.

The entire cohort consisted of 4,401 patients, 584 of whom had undergone laparoscopic surgery for therapeutic purposes;

This retrospective evaluation was performed on a cohort of 4,083 patients with endometriosis that visited the Italian Endometriosis Center in the period 2000-2010.

A non-invasive diagnostic protocol was performed which included vaginal examination with accurate screening of the fornixes of the cervix and the virtual space of the rectal vaginal septum, followed by rectal exploration with screening of the perineum, of the deep rectal canal, of the posterior wall of the uterus, utero-sacral ligaments and inferior branch of Mackenrodt’s ligament. Magnetic resonance imaging was then performed to diagnose any ovarian endometriosis and the upper part of the uterus that escapes the bimanual examinations. Finally, blood tests were prescribed to check serum markers cancer antigen 125, cancer antigen 19.9, homocysteine, 17β-estradiol, vitamin D, anti-Mullerian hormone, free triiodothyronine-3, free triiodothyronine-4, thyroid-stimulating hormone, anti-thyroid antibodies and anti-peroxidase.

 

[Jonathan Edwards]

My reaction to the abstract was similar - it looked like a diagnostic mess. But the paper suggests that they did make an effort to objectively diagnose endometriosis. e.g.

The list of tests looks almost as much a mess as the symptoms analysis.
The problem is that we have no idea who gets referred to this centre and probably not what tests would show in the asymptomatic population.

 

[Jonathan Edwards]

The paper is published in something called In Vivo I have never heard of. The huge range of highly technical papers published makes it look as if this may be where you publish stuff the real journals don't take.