New findings from Cleveland Clinic researchers shed light on the significance of assessing for gynecologic overlap in women presenting with upper gastrointestinal (GI) symptoms such as nausea or gastroparesis. This retrospective chart review, published in Clinical Gastroenterology and Hepatology, compared the GI symptoms and healthcare utilization in women with and without endometriosis.

Uncovering the Link between Gynecology and GI Health

Importance of Evaluating Gynecologic Overlap

Cleveland Clinic researchers have emphasized the critical need to evaluate for gynecologic overlap in women with upper GI symptoms. Endometriosis, typically associated with abdominopelvic pain and heavy periods, often leads to GI symptoms like constipation, bloating, diarrhea, and nausea. Studies suggest that a significant portion of women with endometriosis also develop irritable bowel syndrome (IBS), with rates as high as 52%. Patients with both conditions report lower pain thresholds and more painful menstrual cycles.This highlights the challenge of diagnosing these patients promptly. As Dr. Madison Simons, a gastrointestinal psychologist at Cleveland Clinic's Digestive Disease Institute and lead author, notes, "As long as I've worked in GI, I've noticed a high prevalence of gynecologic conditions in our patients. It's something I've been screening for since early in my career, and this research was a preliminary investigation into women with and without endometriosis with GI conditions and how they present."

Study Design and Findings

The research team reviewed the medical charts of adult women with endometriosis and compared them with those without GI symptoms seen at an outpatient gastroenterology clinic. The final sample consisted of 6,736 women from 2010 to 2022, with 3,236 having endometriosis (GYN) and 3,500 as control subjects (GI). The GYN group was younger and more likely to be non-white. They had significantly higher rates of abdominal pain, abdominal distention, nausea, changes in bowel habits, iron deficiency anemia, and gastroparesis. In contrast, the GI group was more likely to be seen for Crohn's disease and abnormal weight loss.The GYN group also had higher healthcare utilization, with fewer outpatient visits but more hospitalizations, telephone encounters, and abdominal surgeries. The range of emergency department visits for the GYN group was higher than the GI group. These findings show that women with endometriosis have higher healthcare utilization across various aspects.Dr. Simons explains, "We expected that women with multiple conditions would have higher healthcare utilization. But our findings show that women with endometriosis had higher utilization almost across the board. The types of diagnoses we saw in women with endometriosis compared to without were also notable."

Collaboration between Specialties at Cleveland Clinic

Dr. Simons emphasizes the importance of developing relationships between gastroenterologists and gynecologists at Cleveland Clinic. The strong connection between these specialties has facilitated smooth transitions and collaboration. Over the past two years, more gastroenterologists have been exploring gynecologic conditions in patients with GI symptoms, and gynecologists are getting input from gastroenterology colleagues earlier. This has helped identify patients faster, enabling earlier treatments and improving their quality of life."If we're asking questions about gynecologic symptoms right at the front end, we're going to shorten the diagnosis time for this patient population and reduce their healthcare utilization," she concludes.References:Issa B, Onon TS, Agrawal A, et al. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012;61:367–372.