Tuesday, 25 August 2009

Having the Nerve

I think anyone that has been for a laparoscopy to diagnose endometriosis has at some point wondered “isn’t there an easier way?” Unfortunately the answer is ‘no’, which comes as somewhat of a surprise and disappointment even to me. There’s been a great increase in endometriosis research over the last few years (believe it or not) and yet not much has come from it. There are a few new treatment options (which have mostly been retro-designed from cancer therapies) and slightly improved use of imaging techniques such as Ultrasound and MRI, but that’s about it. The average time for diagnosing endometriosis is still somewhere between 8 and 9 years which is wholly unacceptable. It seems that although we have a better understanding of the disease, that knowledge isn’t being put to practical use.

However, there have been some promising new developments that have come to light recently, in particular, there’s been some news about a new diagnostic method for endometriosis. Although I am naturally begrudged to provide a link to a media interpretation of scientific information, a good report on the subject can be found here on the BBC website. The BBC report on one article published in Human Reproduction, but there are actually two, which you can see here and here. Both articles report on the same subject and draw very similar conclusions.

It is all about a new ‘semi-invasive’ diagnostic test for endometriosis that would take a similar form to that of a smear test (albeit a bit more invasive), but it’s called an endometrial biopsy, follow this link for more info on that. What will then happen is that someone will look at the biopsy and count the number of small nerve fibres. The basic finding from the aforementioned studies was that upon analysing these endometrial biopsies, women with endometriosis had significantly more nerve fibres in their endometrium, up to 14 times higher, than women without endo. The good thing about this is that it is a pretty simple test to do and results shouldn’t take long to get. Also the preliminary findings indicate that this test is quite accurate. One report stated 97.5% accuracy and the other stated 91% accuracy, but they did use different methods.

Although these are encouraging results they were only small studies, much more investigation in larger groups of women is needed before this test can be widely adopted. The other problem is that this new test cannot replace a laparoscopy. This test will only be able to tell you if you have endometriosis, a laparoscopy would still have to be performed to tell what the stage the endometriosis is at, where the endometriosis is, and if there are any adhesions or other complications. Nevertheless I can see a promising future for this new test as a screening method. It could be used in women who have only just started presenting with symptoms, or for young women with a family history of endometriosis, allowing for earlier medical intervention, hopefully drastically reducing the delay in diagnosis.

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