Curbside Consultation

Is There a Gender Difference in Reflux Disease? Does This Affect Treatment?

Philip O. Katz, MD. FACG

Despite the prevalence of and large body of research in the field of gastroesophageal reflux, surprisingly, there are scant data addressing the features of GERD in women distinct from men. The clinical impression from personal observations and few studies suggest that the common presentations of GERD are similar in men as in women. In a recent study attempting to examine the features of GERD in women, a similar percentage experienced heartburn, regurgitation, dysphagia, noncardiac chest pain, cough, and/or wheezing as men in the study. There was a trend to a higher frequency of symptoms and slightly increased severity of symptoms in women compared to men; however, the clinical importance of this difference is unclear. The prevalence of hiatal hernia was similar in men and women as well. Though not seen in this study, there does, however, appear to be a difference in the esophageal findings on endoscopy. Patients with erosive esophagitis are more likely to be men, women more likely to have nonerosive disease (heartburn and a normal endoscopy). Some have suggested that this is the result of different symptom sensitivity and/or to different patterns of health-seeking behavior between the sexes; however, neither has been documented. In the aforementioned study, twice as many men had Barrett’s (23%) compared to women (14%), P < .05. At this time the gender ratio for esophageal adenocarcinomas is 8:1 male to female. Again, the reasons for this dramatic difference in this complication is at present unknown. Exposure to acid reflux may be slightly higher in normal or symptomatic men; however, this does not appear of clinical importance. There is no current evidence that women respond any differently to antisecretory therapy or antireflux surgery than men The only change in treatment based on gender should be in the pregnant patient.

This relationship between GERD and obesity was assessed directly using a questionnaire assessing the severity, duration, and frequency of GERD symptoms in participants from the Nurses Health Study. The authors examined the association between body mass index (BMI) and GERD symptoms in these women. Twenty-two percent had symptoms at least weekly, with 55% describing their symptoms as moderate in severity. Women with a BMI greater than 22.5 had an increased odds ratio for frequent symptoms, which increased to an odds ratio of almost three for those with a BMI greater than 35. Of perhaps greater importance, even in women with a normal BMI at baseline, weight gain resulting in an increase of more than 3.5 in BMI increased odds of frequent reflux symptoms compared to those with stable weight. It appears from this study that weight gain of any type is associated with an increase in reflux symptoms. Men were not studied so the differences in gender cannot be ascertained.

In summary, GERD is common in women, likely as frequent as men. Women may have more frequent and severe symptoms but have a lower incidence of Barrett’s esophagus and, to date, esophageal adenocarcinoma. Regardless of the differences, management principles are similar to men and outcomes excellent with proper therapy. Despite the lower incidence of Barrett’s esophagus, women should still discuss the need (option) for screening for this condition with their care provider. There is a clear relationship between BMI and reflux symptoms in women, unstudied in men. GERD symptoms are common in pregnancy but can be safely and successfully managed.

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