TOPLINE:

Women with endometriosis and concurrent inflammatory bowel disease (IBD), particularly Crohn's disease, had a less severe disease progression and required fewer immunosuppressants and biologics than those with IBD alone.

METHODOLOGY:

• Researchers conducted a retrospective study across 18 French and Belgian IBD centres (June 2022 to March 2023) to examine the impact of endometriosis on the course of IBD.
• They analysed data of 207 patients with endometriosis and IBD (mean age, 39.1 years), including 149 patients with Crohn's disease and 58 patients with ulcerative colitis (UC), and compared them with a matched cohort of 409 patients with IBD without endometriosis (mean age, 38.7 years).
• They confirmed the diagnosis of endometriosis through clinical findings by gynaecologists, laparoscopic visualisation of lesions, or pelvic MRI, with lesions classified as superficial peritoneal or ovarian lesions or deep infiltrating endometriosis.
• The primary endpoint was the occurrence of all IBD severity events, including colectomy or a colonic stricture (for UC) and bowel damage (stenosis, fistula, or an intra‑abdominal abscess) or intestinal surgery (for Crohn's disease).
• Secondary endpoints examined outcomes in two subgroups: patients diagnosed with endometriosis before IBD (n = 49) and those who underwent surgery for endometriosis (n = 98).

TAKEAWAY:

• Over a median follow-up duration of 10 years, patients with Crohn's disease and endometriosis had a significantly less severe course of the disease than those without endometriosis (hazard ratio, 0.68; P = .011). Among those with UC, no significant difference in the course of the disease was observed between those with and without endometriosis.
• Patients with both Crohn's disease and endometriosis were less likely than those with Crohn's disease alone to use immunosuppressants (65.1% vs 76.3%; P = .008) or biologics (72.5% vs 88.9%; P < .001).
• Similarly, among patients with UC, those with endometriosis were significantly less likely than those without endometriosis to receive immunosuppressants (46.6% vs 66.4%; P = .005) and biologics (56.9% vs 75.2%; P < .009).
• Endometriosis diagnosed before UC or Crohn's disease did not significantly affect the course of IBD, and surgical treatment for endometriosis had no significant impact on disease progression in either condition.

IN PRACTICE:

"A diagnosis of endometriosis, which can mimic IBD, should therefore be considered by the gastroenterologist in female patients of childbearing age. Although patients with endometriosis are supposed to have a higher risk of developing IBD, the presence of endometriosis does not negatively impact the course of IBD," the authors of the study wrote.

SOURCE:

This study was led by Lucas Guillo, MD, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France. It was published online on December 08, 2025, in Clinical and Translational Gastroenterology.

LIMITATIONS:

The retrospective nature of data collection may have resulted in numerous missing data points. Some information was obtained via telephone interviews, which may have introduced memory bias. The composite severity criterion was not validated and did not include objective signs of disease activity.

DISCLOSURES:

This study did not receive any funding. Two authors reported receiving consulting and personal fees from various pharmaceutical and biotechnology companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.