Intestinal Endometriosis, A Challenge for Gastroenterologists: A Narrative Review

Endometriosis is a medical condition where endometrial tissue and glands are found outside the uterine cavity: on ovaries, pelvic peritoneum, rectovaginal septum, bladder, bowel and more. The ectopic tissue is estrogen dependent and cause inflammation and immune response and is responsible for chronic pain, infertility and disability of these patients. Without a specific biomarker and with a wide range of symptoms, the diagnosis is often overlooked or delayed. Abdominal and pelvic pain together with dysmenorrhea, dyspareunia, irregular bleeding, and cyclic alteration of intestinal habits are a challenging combination of symptoms that characterise endometriosis. One of the less recognized yet significant causes of abdominal pain is intestinal endometriosis. Gastroenterologists and gynecologists must solve the intricate puzzle of gynecological, gastrointestinal and nonspecific symptoms that are present in patients with intestinal endometriosis; further managements should be decided by a multidisciplinary team. This review aims to present the pathogenic mechanisms, diagnostic challenges and treatment while highlighting the importance of recognizing intestinal endometriosis as a potential differential diagnosis in patients with gastrointestinal symptoms.