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Pathogenesis Based Diagnosis and Treatment of Endometriosis

Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, whi...

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Autores principales: Koninckx, Philippe R., Fernandes, Rodrigo, Ussia, Anastasia, Schindler, Larissa, Wattiez, Arnaud, Al-Suwaidi, Shaima, Amro, Bedayah, Al-Maamari, Basma, Hakim, Zeinab, Tahlak, Muna
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656967/
https://www.ncbi.nlm.nih.gov/pubmed/34899597
http://dx.doi.org/10.3389/fendo.2021.745548
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author Koninckx, Philippe R.
Fernandes, Rodrigo
Ussia, Anastasia
Schindler, Larissa
Wattiez, Arnaud
Al-Suwaidi, Shaima
Amro, Bedayah
Al-Maamari, Basma
Hakim, Zeinab
Tahlak, Muna
author_facet Koninckx, Philippe R.
Fernandes, Rodrigo
Ussia, Anastasia
Schindler, Larissa
Wattiez, Arnaud
Al-Suwaidi, Shaima
Amro, Bedayah
Al-Maamari, Basma
Hakim, Zeinab
Tahlak, Muna
author_sort Koninckx, Philippe R.
collection PubMed
description Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, which thus is different from implanted endometrium. The subsequent growth in the specific environment of the peritoneal cavity is associated with angiogenesis, inflammation, immunologic changes and bleeding in the lesions causing fibrosis. Fibrosis will stop the growth and lesions look burnt out. The pain caused by endometriosis lesions is variable: some lesions are not painful while other lesions cause neuroinflammation at distance up to 28 mm. Diagnosis of endometriosis is made by laparoscopy, following an experience guided clinical decision, based on history, symptoms, clinical exam and imaging. Biochemical markers are not useful. For deep endometriosis, imaging is important before surgery, notwithstanding rather poor predictive values when confidence limits, the prevalence of the disease and the absence of stratification of lesions by size, localization and depth of infiltration, are considered. Surgery of endometriosis is based on recognition and excision. Since the surrounding fibrosis belongs to the body with limited infiltration by endometriosis, a rim of fibrosis can be left without safety margins. For deep endometriosis, this results in a conservative excision eventually with discoid excision or short bowel resections. For cystic ovarian endometriosis superficial destruction, if complete, should be sufficient. Understanding pathophysiology is important for the discussion of early intervention during adolescence. Considering neuroinflammation at distance, the indication to explore large somatic nerves should be reconsidered. Also, medical therapy of endometriosis has to be reconsidered since the variability of lesions results in a variable response, some lesions not requiring estrogens for growth and some being progesterone resistant. If the onset of endometriosis is driven by oxidative stress from retrograde menstruation and the peritoneal microbiome, medical therapy could prevent new lesions and becomes indicated after surgery.
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spelling pubmed-86569672021-12-10 Pathogenesis Based Diagnosis and Treatment of Endometriosis Koninckx, Philippe R. Fernandes, Rodrigo Ussia, Anastasia Schindler, Larissa Wattiez, Arnaud Al-Suwaidi, Shaima Amro, Bedayah Al-Maamari, Basma Hakim, Zeinab Tahlak, Muna Front Endocrinol (Lausanne) Endocrinology Understanding the pathophysiology of endometriosis is changing our diagnosis and treatment. Endometriosis lesions are clones of specific cells, with variable characteristics as aromatase activity and progesterone resistance. Therefore the GE theory postulates GE incidents to start endometriosis, which thus is different from implanted endometrium. The subsequent growth in the specific environment of the peritoneal cavity is associated with angiogenesis, inflammation, immunologic changes and bleeding in the lesions causing fibrosis. Fibrosis will stop the growth and lesions look burnt out. The pain caused by endometriosis lesions is variable: some lesions are not painful while other lesions cause neuroinflammation at distance up to 28 mm. Diagnosis of endometriosis is made by laparoscopy, following an experience guided clinical decision, based on history, symptoms, clinical exam and imaging. Biochemical markers are not useful. For deep endometriosis, imaging is important before surgery, notwithstanding rather poor predictive values when confidence limits, the prevalence of the disease and the absence of stratification of lesions by size, localization and depth of infiltration, are considered. Surgery of endometriosis is based on recognition and excision. Since the surrounding fibrosis belongs to the body with limited infiltration by endometriosis, a rim of fibrosis can be left without safety margins. For deep endometriosis, this results in a conservative excision eventually with discoid excision or short bowel resections. For cystic ovarian endometriosis superficial destruction, if complete, should be sufficient. Understanding pathophysiology is important for the discussion of early intervention during adolescence. Considering neuroinflammation at distance, the indication to explore large somatic nerves should be reconsidered. Also, medical therapy of endometriosis has to be reconsidered since the variability of lesions results in a variable response, some lesions not requiring estrogens for growth and some being progesterone resistant. If the onset of endometriosis is driven by oxidative stress from retrograde menstruation and the peritoneal microbiome, medical therapy could prevent new lesions and becomes indicated after surgery. Frontiers Media S.A. 2021-11-25 /pmc/articles/PMC8656967/ /pubmed/34899597 http://dx.doi.org/10.3389/fendo.2021.745548 Text en Copyright © 2021 Koninckx, Fernandes, Ussia, Schindler, Wattiez, Al-Suwaidi, Amro, Al-Maamari, Hakim and Tahlak https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Endocrinology
Koninckx, Philippe R.
Fernandes, Rodrigo
Ussia, Anastasia
Schindler, Larissa
Wattiez, Arnaud
Al-Suwaidi, Shaima
Amro, Bedayah
Al-Maamari, Basma
Hakim, Zeinab
Tahlak, Muna
Pathogenesis Based Diagnosis and Treatment of Endometriosis
title Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_full Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_fullStr Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_full_unstemmed Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_short Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_sort pathogenesis based diagnosis and treatment of endometriosis
topic Endocrinology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8656967/
https://www.ncbi.nlm.nih.gov/pubmed/34899597
http://dx.doi.org/10.3389/fendo.2021.745548
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