Dr. Ron’s Research Review – July 16, 2014

© 2014

This week’s research review focuses on endometriosis and hCG plus celiac.

A recent study examined the effects of human chorionic gonadotrophin (HCG) on endometriosis. Thirty-one patients with histologically verified endometriosis refractory to therapy received 1 to 2 intramuscular injections of 1500 to 5000 IU HCG per week for 3-12 months. Three months of HCG therapy led to a highly significant reduction of endometriosis-related pain (p<0.001, Wilcoxon test) and to improvement of disease-related parameters such as sleeplessness (p<0.001), irritability (p<0.001), overall discomfort (p<0.001), depressive moods (p<0.001) and painful defecation (p=0.01). Dyspareunia and dysmenorrhea also clearly improved (both p<0.001), though HCG did not lead to significant reduction of dysuria (p=0.66). Prolonged therapy with HCG for up to 12 months (mean: 4.42 months) did not lead to reduction of the beneficial effect. (Huber et al., 2004)

Celiac Disease

A recent study found that patients with CD were at increased risk of subsequent endometriosis (HR = 1.39; 95% CI = 1.14-1.70). Risk estimates were highest in the first year after diagnosis (HR = 1.49; 95% CI = 0.83-2.67) and gradually decreased (>5 years after CD diagnosis, HR = 1.33; 95% CI = 1.00-1.79). (Stephansson et al., 2011)

Gluten-Free Diet

Two hundred seven patients with severe painful endometriosis-related symptoms were recommended a gluten-free diet. At 12 month follow-up, 156 patients (75%) reported statistically significant change in painful symptoms (P<0.005), 51 patients (25%) reported not improvement of symptoms. No patients reported worsening of pain. A considerable increase of scores for all domains of physical functioning, general health perception, vitality, social functioning, and mental health was observed in all patients (P<0.005). (Marziali et al., 2012)

Dr. Ron


Articles

 

Systemic HCG treatment in patients with endometriosis: a new perspective for a painful disease.
            (Huber et al., 2004) Download
BACKGROUND: Endometriosis is characterized by the presence of endometrium-like tissue outside the uterus. This condition causes painful periods, chronic pelvic pain, subfertility and a profound reduction in quality of life, especially during women's reproductive years. Currently available medical therapies offer comparatively little therapeutic benefit and are often burdened by considerable side effects. However, since clinical evidence shows that pregnancy leads to alleviation of endometriotic symptoms, we have for the first time examined the effect of human chorionic gonadotrophin (HCG) injections on symptoms such as dysmenorrhea and pelvic pain. PATIENTS AND METHODS: Thirty-one patients with histologically verified endometriosis refractory to therapy received 1 to 2 intramuscular injections of 1500 to 5000 IU HCG per week for a period of 3-12 months. A QoL questionnaire and the visual analog pain intensity scale (VAS) were used to evaluate quality of life and pain intensity, respectively, before and after three months of treatment. RESULTS: Three months of HCG therapy led to a highly significant reduction of endometriosis-related pain (p<0.001, Wilcoxon test) and to improvement of disease-related parameters such as sleeplessness (p<0.001), irritability (p<0.001), overall discomfort (p<0.001), depressive moods (p<0.001) and painful defecation (p=0.01). Dyspareunia and dysmenorrhea also clearly improved (both p<0.001), though HCG did not lead to significant reduction of dysuria (p=0.66). Prolonged therapy with HCG for up to 12 months (mean: 4.42 months) did not lead to reduction of the beneficial effect. CONCLUSIONS: HCG injections lead to significant and clinically relevant reduction in pain intensity and to greatly improved quality of life in women with therapy-refractory endometriosis. The remarkable clinical effect of parenteral HCG in our study will have to be confirmed in additional trials but clearly indicates an extremely promising new perspective in the treatment of endometriosis.

Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?
            (Marziali et al., 2012)  Download
AIM: Pelvic pain affects 4% to 39% of women and accounts for 10-40% of all outpatient gynecologic visits. The etiology of painful endometriosis-related has not been fully delineated. No studies have been published concerning gluten-free diet administered to achieved relief of painful symptoms endometriosis-related. The aim of this retrospective study was to evaluate the effectiveness for the outcomes of endometriosis-related pain and quality of life of gluten-free diet in a follow-up of 12 months in patients with chronic pelvic pain endometriosis-related. METHODS: Two hundred seven patients with severe painful endometriosis-related symptoms entered the study. At enrolment time, the baseline values of painful symptoms were assessed by Visual Analogue Scale (VAS) for dysmenorrhoea, non-menstrual pelvic pain, and dyspareunia. According to VAS, pain severity was scored from 0-10; 0 indicating the absence of pain, and 1-4, 5-7 and 8-10 mild, moderate and severe respectively. A gluten-free diet was submitted to all patients and a new evaluation was performed after 12 months of diet. Student t test was used for statistical analysis. RESULTS: At 12 month follow-up, 156 patients (75%) reported statistically significant change in painful symptoms (P<0.005), 51 patients (25%) reported not improvement of symptoms. No patients reported worsening of pain. A considerable increase of scores for all domains of physical functioning, general health perception, vitality, social functioning, and mental health was observed in all patients (P<0.005). CONCLUSION: In our experience, painful symptoms of endometriosis decrease after 12 months of gluten free diet.

Risk of endometriosis in 11,000 women with celiac disease.
            (Stephansson et al., 2011) Download
BACKGROUND: Endometriosis is a common cause of infertility. Whereas celiac disease (CD) is present in ~1% of individuals in Western Europe, the prevalence in women undergoing investigation for infertility is often >2%. Still, the relationship between CD and endometriosis is unclear. METHODS: We identified 11 097 women with CD (Marsh 3: villous atrophy) through biopsy data from all 28 pathology departments in Sweden. Biopsies had been performed between 1973 and 2008. Data on inpatient and outpatient diagnoses of endometriosis were retrieved from the National Patient Register. We then used the Cox regression to estimate the hazard ratios (HRs) for endometriosis in women with CD to compare with those in 54 992 age-matched control women. RESULTS: During the follow-up, 118 individuals with CD and 399 matched controls developed endometriosis. Hence, patients with CD were at increased risk of subsequent endometriosis [HR = 1.39; 95% confidence interval (CI) = 1.14-1.70]. The absolute risk of endometriosis in patients with CD was 112/100,000 person-years with an excess risk of 31/100,000. Risk estimates were highest in the first year after diagnosis (HR = 1.49; 95% CI = 0.83-2.67) and gradually decreased (>5 years after CD diagnosis, HR = 1.33; 95% CI = 1.00-1.79). CONCLUSION: Endometriosis seems to be associated with prior CD. Potential explanations include shared etiological factors and CD-mediated inflammation.


 

Research

Huber, AV, et al. (2004), ‘Systemic HCG treatment in patients with endometriosis: a new perspective for a painful disease.’, Wien Klin Wochenschr, 116 (24), 839-43. PubMedID: 15690968
Marziali, M, et al. (2012), ‘Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?’, Minerva Chir, 67 (6), 499-504. PubMedID: 23334113
Stephansson, O, H Falconer, and JF Ludvigsson (2011), ‘Risk of endometriosis in 11,000 women with celiac disease.’, Hum Reprod, 26 (10), 2896-901. PubMedID: 21840904