Intestinal permeability and endometriosis: a pilot investigation

The etiology of endometriosis is likely multifactorial with both heritable and non-heritable factors interacting in complex ways. Impaired intestinal permeability may be associated with endometriosis. The objective of this project was to determine whether patients with laparoscopically proven endometriosis have impaired intestinal permeability as compared with healthy controls and pelvic pain patients without endometriosis. This is a proof-of-concept trial. 46 subjects were enrolled. Of these, 35 were patients with pelvic pain (PP) scheduled for laparoscopic surgery. 11 healthy controls (HC) enrolled in the trial. 23 of the PP patients and 6 of the HC subjects completed the trial. Percentage recovery of Lactulose (L) and Mannitol (M) were obtained from urine samples following an oral load of these same 2 sugars to evaluate gut permeability by using a L/M ratio. Out of 20 patients with endometriosis, 9 (45%) had impaired IP at the time of testing. Of the patients who had pelvic pain and no endometriosis, 0 of 3 had impaired IP and 0 of 6 controls had impaired IP. Of the 29 patients who completed the trial, 100% of those who had impaired IP had endometriosis (n = 9). A significant difference was seen between endometriosis and IP (9/20) and patients without endometriosis and IP (0/9) p = 0.027. Total 45% of pelvic pain patients with endometriosis had impaired intestinal permeability, demonstrating a significant association. These results suggest that further research evaluating intestinal permeability and endometriosis may be of value.