Differential diagnosis of bowel diseases. Focus on the comorbidity triad: inflammatory bowel disease, celiac disease, and intestinal endometriosis

Trukhan D.I., Shuganova P.V., Viktorova I.A., Degovtsov E.N.

Omsk State Medical University, Omsk, Russia

Inflammatory bowel disease (IBD), celiac disease, and intestinal endometriosis are included in the differential diagnosis of intestinal pathology. To examine the relationship between IBD, celiac disease, and intestinal endometriosis, we used sources from the PubMed database published before February 25, 2026. A preliminary analysis of the retrieved publications allowed to group these diseases within the comorbidity triad (comorbidity triangle). This review demonstrates common points of contact in the pathogenesis of these diseases (genetic factors, immune disorders, and intestinal dysbiosis). Intestinal symptoms are a unifying factor in this triad; they are more often prominent in the clinical presentation of IBD and celiac disease, but can also be present in the clinical picture of not only intestinal endometriosis but also genital endometriosis. Extraintestinal systemic manifestations are diverse and may also overlap. This review examines comorbidity between individual aspects of the triangle (IBD – endometriosis, IBD – celiac disease, and celiac disease – endometriosis), which provides a valid basis for combining IBD, celiac disease, and intestinal endometriosis/endometriosis within the comorbid triad. The final section examines individual aspects of differential diagnosis within the identified comorbidity triad. The presence of gynecological symptoms in patients with intestinal symptoms requires a multidisciplinary approach to the differential diagnosis of the comorbid triad (IBD, celiac disease, and endometriosis) and close collaboration between a triumvirate of specialists (internist, gynecologist, and surgeon).

For citations: Trukhan D.I., Shuganova P.V., Viktorova I.A., Degovtsov E.N. Differential diagnosis of bowel diseases. Focus on the comorbidity triad: inflammatory bowel disease, celiac disease, and intestinal endometriosis. Pharmateca. 2026;33(6):117-124. (In Russ.). DOI: 
https://dx.doi.org/10.18565/pharmateca.2026.6.117-124

Authors’ contribution: Concept of the article – D.I. Trukhan, P.V. Shuganova. Text development – D.I. Trukhan. Literature review – D.I. Trukhan, P.V. Shuganova, I.A. Viktorova, E.N. Degovtsov. Material analysis – D.I. Trukhan, P.V. Shuganova, I.A. Viktorova, E.N. Degovtsov. Editing – D.I. Trukhan, P.V. Shuganova. Approval of the final version of the article – D.I. Trukhan, P.V. Shuganova, I.A. Viktorova, E.N. Degovtsov.
Conflicts of interest: The authors confirm that they have no conflicts of interest to declare.
Funding: The study was conducted without any sponsorship.

Keywords

About the Authors

Dmitry I. Trukhan, Dr. Sci. (Med.), Associate Professor, Professor, Department of Outpatient Therapy and Internal Medicine, Omsk State Medical University, Omsk, Russia; dmitry_trukhan@mail.ru, ORCID: https://orcid.org/0000-0002-1597-1876 (corresponding author)
Polina V. Shuganova, Assistant Professor, Department of Outpatient Therapy and Internal Medicine, Omsk State Medical University, Omsk, Russia; docanilop@mail.ru, ORCID: https://orcid.org/0009-0009-9935-2164
Inna A. Viktorova, Dr. Sci. (Med.), Professor, Head of the Department of Outpatient Therapy and Internal Medicine, Omsk State Medical University, Omsk, Russia; vic-inna@mail.ru, ORCID: https://orcid.org/0000-0001-8728-2722
Evgeny N. Degovtsov, Dr. Sci. (Med.), Head of the Department of Hospital Surgery named after N.S. Makokha, Omsk State Medical University, Omsk, Russia; edego2001@mail.ru, ORCID: https://orcid.org/0000-0003-0385-8232

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