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:	Philippe R. Koninckx, Rodrigo Fernandes, Anastasia Ussia, Larissa Schindler, Arnaud Wattiez, Shaima Al-Suwaidi, Bedayah Amro, Basma Al-Maamari, Zeinab Hakim, Muna Tahlak
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	endometriosis endometriosis natural history endometriosis diagnosis endometriosis prevention endometriosis treatment endometriosis surgery Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/e65d42ef80414003a4880fe9242a6cab
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spelling	oai:doaj.org-article:e65d42ef80414003a4880fe9242a6cab2021-12-01T02:42:37ZPathogenesis Based Diagnosis and Treatment of Endometriosis1664-239210.3389/fendo.2021.745548https://doaj.org/article/e65d42ef80414003a4880fe9242a6cab2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.745548/fullhttps://doaj.org/toc/1664-2392Understanding 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.Philippe R. KoninckxPhilippe R. KoninckxPhilippe R. KoninckxPhilippe R. KoninckxPhilippe R. KoninckxPhilippe R. KoninckxRodrigo FernandesAnastasia UssiaAnastasia UssiaLarissa SchindlerArnaud WattiezArnaud WattiezShaima Al-SuwaidiBedayah AmroBasma Al-MaamariZeinab HakimMuna TahlakFrontiers Media S.A.articleendometriosisendometriosis natural historyendometriosis diagnosisendometriosis preventionendometriosis treatmentendometriosis surgeryDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	endometriosis endometriosis natural history endometriosis diagnosis endometriosis prevention endometriosis treatment endometriosis surgery Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	endometriosis endometriosis natural history endometriosis diagnosis endometriosis prevention endometriosis treatment endometriosis surgery Diseases of the endocrine glands. Clinical endocrinology RC648-665 Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Rodrigo Fernandes Anastasia Ussia Anastasia Ussia Larissa Schindler Arnaud Wattiez Arnaud Wattiez Shaima Al-Suwaidi Bedayah Amro Basma Al-Maamari Zeinab Hakim Muna Tahlak Pathogenesis Based Diagnosis and Treatment of Endometriosis
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.
format	article
author	Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Rodrigo Fernandes Anastasia Ussia Anastasia Ussia Larissa Schindler Arnaud Wattiez Arnaud Wattiez Shaima Al-Suwaidi Bedayah Amro Basma Al-Maamari Zeinab Hakim Muna Tahlak
author_facet	Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Philippe R. Koninckx Rodrigo Fernandes Anastasia Ussia Anastasia Ussia Larissa Schindler Arnaud Wattiez Arnaud Wattiez Shaima Al-Suwaidi Bedayah Amro Basma Al-Maamari Zeinab Hakim Muna Tahlak
author_sort	Philippe R. Koninckx
title	Pathogenesis Based Diagnosis and Treatment of Endometriosis
title_short	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_sort	pathogenesis based diagnosis and treatment of endometriosis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e65d42ef80414003a4880fe9242a6cab
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Pathogenesis Based Diagnosis and Treatment of Endometriosis

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