Danish researchers have developed a new classification system to monitor treatment efficacy and disease progression in women with bowel endometriosis syndrome (BENS). The novel score system is based on symptom and quality of life (QoL) reports from patients themselves.
Their study, “Bowel Endometriosis Syndrome: a new scoring system for pelvic organ dysfunction and quality of life,” appeared in the journal Human Reproduction.
Several scores have been developed to help classify the progression and severity of endometriosis, taking into account all potential characteristics of this complex disease. These include the widely accepted American Society for Reproductive Medicine (ASRM) score, the ENZIAN score, and the Endometriosis Fertility Index (EFI). Each of these classification systems feature anatomical and surgical findings related to endometriosis, but they fail to recognize all aspects of the disease.
A team of researchers at Denmark’s Aarhus University Hospital, along with others at Herlev and Copenhagen University Hospitals, worked together to develop a new system that could recognize and accurately assess the features of women suffering from bowel endometriosis.
Bowel endometriosis can affect multiple organs, as well as the urinary, genital and gastrointestinal tract. Women with such conditions, which the researchers identify as BENS, often experience painful urination, irregular bleeding, menstrual cramps, constipation or diarrhea.
“The aims of the present study were to develop and validate a simple, reproducible score for clinical evaluation of the severity of BENS, and to identify which aspects of the disease have the greatest impact on health-related QoL as perceived by the patient,” researchers wrote.
The team developed and validated its BENS score system based on data collected from 525 women with medically or surgically treated bowel endometriosis who were treated at Aarhus and Copenhagen University Hospitals between December 2010 and April 2017.
All participants filled in questionnaires assessing pelvic pain, QoL and urinary, sexual and bowel function. Upon statistical analysis, the researchers selected pelvic pain, analgesics consumption, painful defecation, straining to urinate, fecal urgency and sexual satisfaction as key variables for the BENS final score determination.
The BENS score classified patients according to a 28-point scale divided into three categories: “no BENS” (0-8 points), “minor BENS” (9-16 points), and “major BENS” (17-28 points).
“The BENS score is the first classification system within the field of endometriosis to be based on patient reported symptoms and QoL,” wrote researchers, adding that their new system could assess patients’ QoL with an accuracy of 81.6 percent, compared to patients’ self-reported QoL. In addition, the system recognized patients that reported “fair” or “poor” quality of life.
“We have developed a score that can be used in the everyday clinical practice to identify women with BENS and to monitor the effect of medical and surgical management of women suffering from bowel endometriosis,” authors concluded. “Validation in other languages will promote comparison of treatments and results across borders.”
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