P0544 - Endometriosis Is Associated With Higher Healthcare Utilization and Upper Gastrointestinal Symptoms

Sunday, October 22, 2023

3:30 PM – 7:00 PM PT

Location: Exhibit Hall

Presenting Author(s)

Madison Simons, PhD (she/her/hers)

Cleveland Clinic Foundation
Cleveland, OH

Madison Simons, PhD¹, Samita Garg, MD¹, Scott Gabbard, MD¹, Matthew Hoscheit, MD¹, Anthony Lembo, MD², Michael Cline, DO¹, Stephen Lupe, PhD¹
¹Cleveland Clinic Foundation, Cleveland, OH; ²Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH

Introduction: Endometriosis is a common gynecologic disease with primary symptoms of abdominopelvic pain, painful menses, and abnormal menstrual bleeding. 90% of patients experience gastrointestinal (GI) symptoms, including constipation, bloating, and nausea/vomiting. Thus, patients can be unsure of the origin of their symptoms and may first seek care for digestive issues, delaying diagnosis and treatment for endometriosis. We sought to compare digestive complaints and healthcare utilization (HCU) among women seen in an outpatient GI clinic with endometriosis/adenomyosis (GYN) to those without (GI).

Methods: A retrospective chart review was completed including adult women seen in the outpatient GI clinic at a tertiary care center between 2011-2022. Data collected from the electronic medical record included: demographics, GI diagnoses (ICD 10 codes), and HCU (number of outpatient visits, ED visits, hospitalizations, phone encounters, abdominal surgeries). Two group comparisons were described using t-tests for continuous variables and medians and quartiles for variables with non-normal distributions.

Results: 6736 patients: mean(SD) age=53.8(16.8) years, 78.2% White, 84.9% Non-Hispanic. The GYN group had more ED visits, phone encounters and abdominal surgeries than the GI group (p< 0.001). The GYN group were significantly more likely to have abdominal pain (RUQ, epigastric, etc.), abdominal distension, nausea, change in bowel habits, and gastroparesis (Table 1). The GI group significantly less likely to be seen for Crohn’s, autoimmune hepatitis, and liver disease (p< 0.001).

Discussion: Women with endometriosis/adenomyosis have higher rates of healthcare utilization and are more likely to be seen for GI complaints including upper abdominal pain, nausea, and distension. This may be related to underlying visceral sensitivity in the abdominopelvic region, though additional study is necessary to understand the etiology and characteristics of digestive complaints in endometriosis. It is important to screen for gynecologic conditions in women presenting for evaluation of digestive symptoms.

Figure: ICD-10 Diagnoses by Group

Healthcare Utilization	Control		Endometriosis
	N	Statistics	N	Statistics
Outpatient Visits, median [Q1, Q3]	3,500	2.0 [1.00, 4.0]	3,236	2.0 [1.00, 4.0]
Outpatient Visits, median (min, max)	3,500	2.0 (0.00, 122.0)	3,236	2.0 (0.00, 6.00)
ED Visits, median [Q1, Q3]***	3,500	0.00 [0.00, 3.00]	3,236	2.0 [0.00, 5.0]
ED Visits, median (min, max)	3,500	0.00 (0.00, 88.0)	3,236	2.0 (0.00, 327.0)
Hospitalizations, median [Q1, Q3]	3,500	0.00 [0.00, 1.00]	3,236	0.00 [0.00, 2.00]
Hospitalizations, median (min, max)	3,500	0.00 (0.00, 66.0)	3,236	0.00 (0.00, 147.0)
Phone encounters, median [Q1, Q3]***	3,500	0.00 [0.00, 1.00]	3,236	1.00 [0.00, 2.0]
Phone encounters, median (min, max)	3,500	0.00 (0.00, 195.0)	3,236	1.00 (0.00, 70.0)
Abdominal surgeries, median [Q1, Q3]***	3,500	0.00 [0.00, 0.00]	3,236	3.00 [1.00, 6.00]
Abdominal surgeries, median (min, max)	3,500	0.00 (0.00, 61.0)	3,236	3.0 (0.00, 5.0)

Table: Title: Comparison of Healthcare Utilization Between Groups
*** p<0.001

Disclosures:

Madison Simons indicated no relevant financial relationships.

Samita Garg indicated no relevant financial relationships.

Scott Gabbard indicated no relevant financial relationships.

Matthew Hoscheit indicated no relevant financial relationships.

Anthony Lembo: AEON Biopharma Inc. – Consultant. Alkermes – Consultant. Allakos – Consultant. Allurion – Stock Options. Anji Pharmaceuticals – Consultant. Arena Pharmaceuticals – Consultant. BioAmerica – Consultant. Bristol Myers Squibb – Stock Options. Gemelli Biotech – Consultant. Ironwood Pharmaceuticals – Consultant. Johnson & Johnson – Stock Options. Maunea Kea – Consultant. Neurogastrx, Inc. – Consultant. OrphoMed, Inc. – Consultant. Pfizer – Consultant. QOL Medical – Consultant. Shire, a Takeda company – Consultant. Takeda Pharmaceuticals – Consultant. Vibrant Pharma, Inc. – Consultant.

Michael Cline: Evoke Pharma – Advisor or Review Panel Member.

Stephen Lupe: Ayble Health – Consultant.

Madison Simons, PhD¹, Samita Garg, MD¹, Scott Gabbard, MD¹, Matthew Hoscheit, MD¹, Anthony Lembo, MD², Michael Cline, DO¹, Stephen Lupe, PhD¹. P0544 - Endometriosis Is Associated With Higher Healthcare Utilization and Upper Gastrointestinal Symptoms, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.