**7. Conclusion**

There appears to be co-existence of gastrointestinal symptoms and endometriosis. The linkage between gastrointestinal symptoms and endometriosis may be due the psychological back‐ ground and neuro-endocrine mediation. Gastrointestinal symptoms have been related to both dietary indiscretion and psychological stress both of which may, for a variety of reasons, be commonly encountered in women with endometriosis. Moreover treatment of the symptoms of endometriosis may aggravate gastrointestinal symptoms.

[6] Muscat Baron Y, Dingli M, Camilleri Agius R, Brincat M. Endometriosis and Dietary Intolerance – a Connection. Journal of Italian Obstetrics and Gynaecology 2012; 1: 252

Functional Gastrointestinal Symptoms in Women with Pelvic Endometriosis

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179

[7] Kang JY. Systematic review: geographical and ethnic differences in gastro-oesopha‐

[8] Grainger S L, Klass H J, Rake M O. et al. Prevalence of dyspepsia: the epidemiology

[9] Doll R, Avery Jones F, Buckatzsch M M. Occupational factors in the aetiology of gas‐ tric and duodenal ulcers, with an estimate of their incidence in the general popula‐

[10] Weir R D, Backett E M. Studies of the epidemiology of peptic ulcer in a rural com‐ munity: prevalence and natural history of dyspepsia and peptic ulcer. Gut 1968;

[11] Jones R H, Lydeard S. Prevalence of symptoms of dyspepsia in the community. BMJ

[12] Gill D, Mayou R, Dawes M. et al Presentation, management and course of angina and suspected angina in primary care. J Psychosom Res 1999; 46349–358.358.

[13] Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, Benzi G, Fedele L. Selected food intake and risk of endometriosis. A prospective study of diet‐ ary fat consumption and endometriosis risk. Human Reproduction 2004; 19: 1755-9.

[14] Björnsson B, Orvar KB, Theodórs A, Kjeld M. The relationship of gastrointestinal symptoms and menstrual cycle phase in young healthy women. Laeknabladid

[15] Moore J, Barlow D, Jewell D, Kennedy S. Do gastrointestinal symptoms vary with the

[16] Sepulcri R de P, do Amaral VF. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis. European Journal Obstetric Gynecological Repro‐

[17] Lorençatto C, Petta CA, Navarro MJ, Bahamondes L, Matos A. Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstetrica Gynecolo‐

[18] Souza C, Oliveira L, Scheffel C, Genro V, Rosa V, Chaves M, Cunha Filho J. Quality of life associated to chronic pelvic pain is independent of endometriosis diagnosis-a

[19] Smorgick N, Marsh CA, As-Sanie S, Smith YR, Quint EH. Prevalence of Pain Syn‐ dromes, Mood Conditions, and Asthma in Adolescents and Young Women with En‐

menstrual cycle? Br J Obstet Gynaecol. 1998 Dec;105(12):1322-5.

cross-sectional survey. Health Quality Life Outcomes 2011;9: 41.

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tion. London: HMSO, 1951

In suspected endometriosis, meticulous consultation carefully assessing the woman's symp‐ tomatology is required to avoid delay or possibly misdiagnosis. A delay or misdiagnosis may further exacerbate the psychological background of anxiety and depression, together with the incidence of gastrointestinal symptoms. The co-existence of gastrointestinal conditions and endometriosis may require a multi-disciplinary approach to enact effective treatment.

#### **Author details**

Yves Muscat Baron\*

Address all correspondence to: yambaron@go.net.mt; yves.muscat.baron@gov.mt

Department of Obstetrics and Gynaecology, Mater Dei University Hospital, Msida, Malta

#### **References**


[6] Muscat Baron Y, Dingli M, Camilleri Agius R, Brincat M. Endometriosis and Dietary Intolerance – a Connection. Journal of Italian Obstetrics and Gynaecology 2012; 1: 252 – 256.

**7. Conclusion**

178 Dyspepsia - Advances in Understanding and Management

**Author details**

Yves Muscat Baron\*

**References**

There appears to be co-existence of gastrointestinal symptoms and endometriosis. The linkage between gastrointestinal symptoms and endometriosis may be due the psychological back‐ ground and neuro-endocrine mediation. Gastrointestinal symptoms have been related to both dietary indiscretion and psychological stress both of which may, for a variety of reasons, be commonly encountered in women with endometriosis. Moreover treatment of the symptoms

In suspected endometriosis, meticulous consultation carefully assessing the woman's symp‐ tomatology is required to avoid delay or possibly misdiagnosis. A delay or misdiagnosis may further exacerbate the psychological background of anxiety and depression, together with the incidence of gastrointestinal symptoms. The co-existence of gastrointestinal conditions and endometriosis may require a multi-disciplinary approach to enact effective treatment.

Address all correspondence to: yambaron@go.net.mt; yves.muscat.baron@gov.mt

Department of Obstetrics and Gynaecology, Mater Dei University Hospital, Msida, Malta

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**Chapter 10**

**Dyspepsia and Opioid–Induced Bowel Dysfunction: The**

Opioid analgesics are commonly and in most cases effectively used to manage chronic pain of moderate to severe intensity. Apart from analgesia, opioids exert numerous adverse ef‐ fects, several of which impact the gastrointestinal (GI) tract. The chronic use of opioid anal‐ gesics in fact is commonly associated with adverse effects on the gastrointestinal tract. [1] Opioid–induced bowel dysfunction (OIBD) comprises gastrointestinal symptoms such as dry mouth, anorexia, gastroesophageal reflux (GERD), delayed digestion, abdominal pain, flatulence, bloating, nausea, vomiting, and constipation with hard stool and incomplete evacuation. Further, side effects from long–term opioid therapy may result in more serious intestinal complications such as faecal impaction with overflow diarrhea and incontinence, pseudo–obstruction (causing anorexia, nausea and vomiting), disturbance of drug absorp‐ tion, and urinary retention and incontinence. OIBD may also lead to inappropriate opioid dosing and in consequence, insufficient analgesia. As a result, OIBD significantly deteriorate patients' quality of life and compliance with their treatment. Approximately one-third of pa‐ tients treated with opioid analgesics do not adhere to the prescribed opioid regimen or sim‐

Several strategies have been advocated to prevent or treat OIBD. Use of traditional laxatives is limited by their effectiveness, yet conveys their own adverse effects. Other possibilities comprise an opioid switch or changing the opioid administration route. New therapies now target opioid receptors in the gut as they represent a main source of OIBD symptoms. A combination of an opioid and opioid antagonist (oxycodone/naloxone) in prolonged release tablets and purely peripherally acting opioid receptor antagonist (methylnaltrexone) availa‐ ble in subcutaneous injections are currently available treatment options. This chapter re‐

> © 2013 Leppert; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

views the pathophysiological basis and possible treatment strategies for OIBD.

**Role of Opioid Receptor Antagonists**

Additional information is available at the end of the chapter

ply quit the treatment due to OIBD symptoms [2].

Wojciech Leppert

**1. Introduction**

http://dx.doi.org/10.5772/56624

**Chapter 10**
