Gender Difference in Functional Gastrointestinal Disorders

Ju Yup Lee; Kyung Sik Park

doi:10.4166/kjg.2018.72.4.163

Journal List > Korean J Gastroenterol > v.72(4) > 1106208

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee and Park: Gender Difference in Functional Gastrointestinal Disorders

Review Article

The Korean Journal of Gastroenterology 2018; 72(4): 163-169.

Published online: 30 October 2018

DOI: https://doi.org/10.4166/kjg.2018.72.4.163

Gender Difference in Functional Gastrointestinal Disorders

Ju Yup Lee, Kyung Sik Park

Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.

Correspondence to: Kyung Sik Park, Department of Internal Medicine, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea. Tel: +82-53-250-7088, Fax: +82-53-250-7442, seenae99@dsmc.or.kr

Received 13 September 2018 Revised 17 October 2018 Accepted 17 October 2018

Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Functional gastrointestinal diseases (FGIDs) are known to be influenced more by a lowering of the quality of life, such as mental health and sleep quality, compared to organic diseases. Genetic, microbiological, molecular biological, and social environmental factors are involved in the pathophysiology of FGIDs. In particular, mental factors, such as depression and anxiety, play a major role in the development of FGIDs. The prevalence of most FGIDs is higher in women. Gender needs to be analyzed in patients with FGIDs because it can have a great influence on the onset of FGIDs. Because there are differences in the treatment response according to gender, further research in the development of therapeutic drugs considering this gender difference will be needed, and ultimately it will be possible to lower the prevalence of FGIDs and improve the quality of life of patients.

Keywords: Sex, Gender, Irritable bowel syndromes, Functional gastrointestinal disorders

Figures and Tables

Fig. 1

Cumulative life course risk factors for non-communicable disease. As adults become older and older, the influence of gender related to social factors is greater than that of their biological gender. Adapted from Darnton-Hill et al.22, with permission from Public Health Nutr.

Table 1

The Effect of Gender on the Prevalence of FGID17

FGID, functional gastrointestinal disorder; F, female; M, male; GI, gastrointestinal; IBS, irritable bowel syndrome.

Table 2

Gender Difference in FGID Symptoms4

FGID, functional gastrointestinal disorder; IBS, irritable bowel syndrome; RR, relative risk; CI, confidence interval; N/A, not applicable due to insufficient data.

^aMeans statistical significance.

Notes

^{Financial support} None.

^{Conflict of interest} None.

References

1. El-Serag HB, Talley NJ. Health-related quality of life in functional dyspepsia. Aliment Pharmacol Ther. 2003; 18:387–393.

2. Miwa H, Watari J, Fukui H, et al. Current understanding of pathogenesis of functional dyspepsia. J Gastroenterol Hepatol. 2011; 26:Suppl 3. 53–60.

3. Aro P, Talley NJ, Ronkainen J, et al. Anxiety is associated with uninvestigated and functional dyspepsia (Rome III criteria) in a Swedish population-based study. Gastroenterology. 2009; 137:94–100.

4. Adeyemo MA, Spiegel BM, Chang L. Meta-analysis: do irritable bowel syndrome symptoms vary between men and women? Aliment Pharmacol Ther. 2010; 32:738–755.

5. Heitkemper MM, Chang L. Do fluctuations in ovarian hormones affect gastrointestinal symptoms in women with irritable bowel syndrome? Gend Med. 2009; 6:Suppl 2. 152–167.

6. Chang L, Lee OY, Naliboff B, Schmulson M, Mayer EA. Sensation of bloating and visible abdominal distension in patients with irritable bowel syndrome. Am J Gastroenterol. 2001; 96:3341–3347.

7. Chang L, Mayer EA, Labus JS, et al. Effect of sex on perception of rectosigmoid stimuli in irritable bowel syndrome. Am J Physiol Regul Integr Comp Physiol. 2006; 291:R277–R284.

8. Arendt-Nielsen L, Bajaj P, Drewes AM. Visceral pain: gender differences in response to experimental and clinical pain. Eur J Pain. 2004; 8:465–472.

9. Chang L, Adeyemo M, Karagiannides I, et al. Serum and colonic mucosal immune markers in irritable bowel syndrome. Am J Gastroenterol. 2012; 107:262–272.

10. Cain KC, Jarrett ME, Burr RL, Rosen S, Hertig VL, Heitkemper MM. Gender differences in gastrointestinal, psychological, and somatic symptoms in irritable bowel syndrome. Dig Dis Sci. 2009; 54:1542–1549.

11. Filkowski MM, Olsen RM, Duda B, Wanger TJ, Sabatinelli D. Sex differences in emotional perception: meta analysis of divergent activation. Neuroimage. 2017; 147:925–933.

12. Kano M, Farmer AD, Aziz Q, et al. Sex differences in brain response to anticipated and experienced visceral pain in healthy subjects. Am J Physiol Gastrointest Liver Physiol. 2013; 304:G687–G699.

13. Berman SM, Naliboff BD, Suyenobu B, et al. Sex differences in regional brain response to aversive pelvic visceral stimuli. Am J Physiol Regul Integr Comp Physiol. 2006; 291:R268–R276.

14. Kim YS, Kim N. Sex-gender differences in irritable bowel syndrome. J Neurogastroenterol Motil. 2018; 24:544–558.

15. Pardue ML, Wizemann TM. Exploring the biological contributions to human health: does sex matter? Washington: National Academies Press;2001.

16. Chang L, Toner BB, Fukudo S, et al. Gender, age, society, culture, and the patient's perspective in the functional gastrointestinal disorders. Gastroenterology. 2006; 130:1435–1446.

17. Houghton LA, Heitkemper M, Crowell M, et al. Age, gender and women's health and the patient. Gastroenterology. 2016; 150:1332–1343.e4.

18. Regitz-Zagrosek V. Sex and gender differences in health. Science & Society Series on Sex and Science. EMBO Rep. 2012; 13:596–603.

19. Hankivsky O. Women's health, men's health, and gender and health: implications of intersectionality. Soc Sci Med. 2012; 74:1712–1720.

20. Schiebinger L, Klinge I, Paik HY, Sánchez de Madariaga I, Schraudner M, Stefanick M, editors. Gendered Innovations in Science, Health & Medicine, Engineering, and Environment. [Internet]. Stanford: cited 2018 Oct 15. Available from: http://genderedinnovations.stanford.edu.

21. Walker A. Why the UK needs a social policy on ageing. Jnl Soc Pol. 2018; 47:253–273.

22. Darnton-Hill I, Nishida C, James WP. A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr. 2004; 7:101–121.

23. Bradford K, Shih W, Videlock EJ, et al. Association between early adverse life events and irritable bowel syndrome. Clin Gastroenterol Hepatol. 2012; 10:385–390. 390.e1–390.e3.

24. Longstreth GF, Wolde-Tsadik G. Irritable bowel-type symptoms in HMO examinees. Prevalence, demographics, and clinical correlates. Dig Dis Sci. 1993; 38:1581–1589.

25. Walker EA, Katon WJ, Roy-Byrne PP, Jemelka RP, Russo J. Histories of sexual victimization in patients with irritable bowel syndrome or inflammatory bowel disease. Am J Psychiatry. 1993; 150:1502–1506.

26. Goodwin L, White PD, Hotopf M, Stansfeld SA, Clark C. Life course study of the etiology of self-reported irritable bowel syndrome in the 1958 British birth cohort. Psychosom Med. 2013; 75:202–210.

27. Jones MP, Oudenhove LV, Koloski N, Tack J, Talley NJ. Early life factors initiate a ‘vicious circle’ of affective and gastrointestinal symptoms: a longitudinal study. United European Gastroenterol J. 2013; 1:394–402.

28. Cheney AM. “Most girls want to be skinny”: body (dis)satisfaction among ethnically diverse women. Qual Health Res. 2011; 21:1347–1359.

29. Björkman I, Dellenborg L, Ringström G, Simrén M, Jakobsson Ung E. The gendered impact of Irritable Bowel syndrome: a qualitative study of patients' experiences. J Adv Nurs. 2014; 70:1334–1343.

30. Ali A, Toner BB, Stuckless N, et al. Emotional abuse, self-blame, and self-silencing in women with irritable bowel syndrome. Psychosom Med. 2000; 62:76–82.

31. Simrén M, Abrahamsson H, Svedlund J, Björnsson ES. Quality of life in patients with irritable bowel syndrome seen in referral centers versus primary care: the impact of gender and predominant bowel pattern. Scand J Gastroenterol. 2001; 36:545–552.

32. Tang YR, Yang WW, Wang YL, Lin L. Sex differences in the symptoms and psychological factors that influence quality of life in patients with irritable bowel syndrome. Eur J Gastroenterol Hepatol. 2012; 24:702–707.

33. Welén K, Faresjö A, Faresjö T. Functional dyspepsia affects women more than men in daily life: a case-control study in primary care. Gend Med. 2008; 5:62–73.

34. Chang L, Heitkemper MM. Gender differences in irritable bowel syndrome. Gastroenterology. 2002; 123:1686–1701.

35. Kim YS, Kim N, Kim GH. Sex and gender differences in gastroesophageal reflux disease. J Neurogastroenterol Motil. 2016; 22:575–588.

36. Knuesel C, Oulevey-Meier M, Flogerzi B, et al. Effect of estrogen on visceral sensory function in a non-inflammatory colonic hypersensitivity rat model. Neurogastroenterol Motil. 2016; 28:1570–1579.

37. Prusator DK, Greenwood-Van Meerveld B. Sex-related differences in pain behaviors following three early life stress paradigms. Biol Sex Differ. 2016; 7:29.

38. Ryan JP, Bhojwani A. Colonic transit in rats: effect of ovariectomy, sex steroid hormones, and pregnancy. Am J Physiol. 1986; 251(1 Pt 1):G46–G50.

39. Taché Y, Million M, Nelson AG, Lamy C, Wang L. Role of corticotropin-releasing factor pathways in stress-related alterations of colonic motor function and viscerosensibility in female rodents. Gend Med. 2005; 2:146–154.

40. Mearadji B, Penning C, Vu MK, et al. Influence of gender on proximal gastric motor and sensory function. Am J Gastroenterol. 2001; 96:2066–2073.

41. Mori H, Suzuki H, Matsuzaki J, et al. Gender difference of gastric emptying in healthy volunteers and patients with functional dyspepsia. Digestion. 2017; 95:72–78.

42. Lovell RM, Ford AC. Effect of gender on prevalence of irritable bowel syndrome in the community: systematic review and meta-analysis. Am J Gastroenterol. 2012; 107:991–1000.

43. Bangasser DA, Valentino RJ. Sex differences in molecular and cellular substrates of stress. Cell Mol Neurobiol. 2012; 32:709–723.

44. Weiser MJ, Handa RJ. Estrogen impairs glucocorticoid dependent negative feedback on the hypothalamic-pituitary-adrenal axis via estrogen receptor alpha within the hypothalamus. Neuroscience. 2009; 159:883–895.

45. Chaban V. Estrogen modulation of visceral nociceptors. Curr Trends Neurol. 2013; 7:51–55.

46. Chadwick VS, Chen W, Shu D, et al. Activation of the mucosal immune system in irritable bowel syndrome. Gastroenterology. 2002; 122:1778–1783.

47. Goral V, Kucukoner M, Buyukbayram H. Mast cells count and serum cytokine levels in patients with irritable bowel syndrome. Hepatogastroenterology. 2010; 57:751–754.

48. Mahadeva S, Goh KL. Epidemiology of functional dyspepsia: a global perspective. World J Gastroenterol. 2006; 12:2661–2666.

49. Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the United States: prevalence and impact. Dig Dis Sci. 2000; 45:1166–1171.

50. Taub E, Cuevas JL, Cook EW 3rd, Crowell M, Whitehead WE. Irritable bowel syndrome defined by factor analysis. Gender and race comparisons. Dig Dis Sci. 1995; 40:2647–2655.

51. Zuckerman MJ, Nguyen G, Ho H, Nguyen L, Gregory GG. A survey of irritable bowel syndrome in Vietnam using the Rome criteria. Dig Dis Sci. 2006; 51:946–951.

52. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991; 101:927–934.

53. Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut. 1998; 42:690–695.

54. Lee OY, Mayer EA, Schmulson M, Chang L, Naliboff B. Gender-related differences in IBS symptoms. Am J Gastroenterol. 2001; 96:2184–2193.

55. Masud MA, Hasan M, Khan AK. Irritable bowel syndrome in a rural community in Bangladesh: prevalence, symptoms pattern, and health care seeking behavior. Am J Gastroenterol. 2001; 96:1547–1552.

56. Si JM, Wang LJ, Chen SJ, Sun LM, Dai N. Irritable bowel syndrome consulters in Zhejiang province: the symptoms pattern, predominant bowel habit subgroups and quality of life. World J Gastroenterol. 2004; 10:1059–1064.

57. Smith RC, Greenbaum DS, Vancouver JB, et al. Gender differences in Manning criteria in the irritable bowel syndrome. Gastroenterology. 1991; 100:591–595.

58. Thompson WG. Gender differences in irritable bowel symptoms. Eur J Gastroenterol Hepatol. 1997; 9:299–302.

59. Lu CL, Chang FY, Lang HC, Chen CY, Luo JC, Lee SD. Gender difference on the symptoms, health-seeking behaviour, social impact and sleep quality in irritable bowel syndrome: a Rome II-based survey in an apparent healthy adult Chinese population in Taiwan. Aliment Pharmacol Ther. 2005; 21:1497–1505.

60. Perveen I, Hasan M, Masud MA, Bhuiyan MM, Rahman MM. Irritable bowel syndrome in a Bangladeshi urban community: prevalence and health care seeking pattern. Saudi J Gastroenterol. 2009; 15:239–243.

61. Ringel Y, Williams RE, Kalilani L, Cook SF. Prevalence, characteristics, and impact of bloating symptoms in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2009; 7:68–72. quiz 3.

62. Schmulson M, Adeyemo M, Gutiérrez-Reyes G, et al. Differences in gastrointestinal symptoms according to gender in Rome II positive IBS and dyspepsia in a Latin American population. Am J Gastroenterol. 2010; 105:925–932.

63. Celebi S, Acik Y, Deveci SE, et al. Epidemiological features of irritable bowel syndrome in a Turkish urban society. J Gastroenterol Hepatol. 2004; 19:738–743.

64. Han SH, Lee OY, Bae SC, et al. Prevalence of irritable bowel syndrome in Korea: population-based survey using the Rome II criteria. J Gastroenterol Hepatol. 2006; 21:1687–1692.

65. Thompson WG, Irvine EJ, Pare P, Ferrazzi S, Rance L. Functional gastrointestinal disorders in Canada: first population-based survey using Rome II criteria with suggestions for improving the questionnaire. Dig Dis Sci. 2002; 47:225–235.

66. Pelletier R, Khan NA, Cox J, et al. Sex versus gender-related characteristics: which predicts outcome after acute coronary syndrome in the young? J Am Coll Cardiol. 2016; 67:127–135.

67. Gonsalkorale WM, Houghton LA, Whorwell PJ. Hypnotherapy in irritable bowel syndrome: a large-scale audit of a clinical service with examination of factors influencing responsiveness. Am J Gastroenterol. 2002; 97:954–961.

68. Gonsalkorale WM, Miller V, Afzal A, Whorwell PJ. Long term benefits of hypnotherapy for irritable bowel syndrome. Gut. 2003; 52:1623–1629.

69. Ahlawat SK, Richard Locke G, Weaver AL, Farmer SA, Yawn BP, Talley NJ. Dyspepsia consulters and patterns of management: a population-based study. Aliment Pharmacol Ther. 2005; 22:251–259.

70. Keers R, Aitchison KJ. Gender differences in antidepressant drug response. Int Rev Psychiatry. 2010; 22:485–500.

71. Parker G, Parker K, Austin MP, Mitchell P, Brotchie H. Gender differences in response to differing antidepressant drug classes: two negative studies. Psychol Med. 2003; 33:1473–1477.

72. Camilleri M, Mayer EA, Drossman DA, et al. Improvement in pain and bowel function in female irritable bowel patients with alosetron, a 5-HT3 receptor antagonist. Aliment Pharmacol Ther. 1999; 13:1149–1159.

73. Muller-Lissner SA, Fumagalli I, Bardhan KD, et al. Tegaserod, a 5-HT(4) receptor partial agonist, relieves symptoms in irritable bowel syndrome patients with abdominal pain, bloating and constipation. Aliment Pharmacol Ther. 2001; 15:1655–1666.

74. Kellow J, Lee OY, Chang FY, et al. An Asia-Pacific, double blind, placebo controlled, randomised study to evaluate the efficacy, safety, and tolerability of tegaserod in patients with irritable bowel syndrome. Gut. 2003; 52:671–676.

75. Nyhlin H, Bang C, Elsborg L, et al. A double-blind, placebo-controlled, randomized study to evaluate the efficacy, safety and tolerability of tegaserod in patients with irritable bowel syndrome. Scand J Gastroenterol. 2004; 39:119–126.

TOOLS

ORCID iDs: Kyung Sik Park
https://orcid.org/0000-0003-1874-9936
Similar articles