Features of gastroesophageal reflux disease in women

Gastroesophageal reflux disease (GERD) is as common in women as in men, and may present with various symptoms, such as heartburn, regurgitation, dysphagia, or chest pain. In this study, we evaluated the patterns of symptomatic GERD and the spectrum of disease activity in women and compared them to a cohort of disease- and age-matched men.

We studied 543 adults, both men and women, referred for evaluation because of symptoms or signs suggestive of GERD. All patients were assessed immediately before testing using a standardized symptom questionnaire. Endoscopic, ambulatory pH, and motility findings were categorized and graded according to their extent and severity. The prevalence, nature, and severity of esophageal symptoms and their relationship to endoscopic disease severity were then analyzed. Comparisons were made between the two groups, i.e., 341 men (mean age 54, age range 25-90) and 202 women (mean age 50, age range 22-80).

Heartburn without esophagitis was noted in 38% of men and 55% of women patients. Hiatal hernia was noted in 28% of men and in 26% of women. There were no differences in the magnitude of esophageal acid exposure by pH criteria and motility abnormalities between the two groups. The prevalence of endoscopic stages of GERD (0-IV, Savary-Miller classification) was similar between the two groups (p > 0.1, chi2 test) but women were less likely to harbor Barrett's esophagus (p < 0.05, chi2 test). Quantitative esophageal symptom analysis revealed significantly higher symptom severity scores for heartburn (p < 0.01), regurgitation (p < 0.05), belching (p < 0.01), and nocturnal (p < 0.01) symptoms in women as compared to men. Women also experienced higher symptoms scores of lower abdominal symptoms, such as abdominal pain, diarrhea, and constipation (p < 0.01).

Among symptomatic adults undergoing evaluation for GERD, women appear to have generally similar patterns of endoscopic severity of GERD as men but they are less likely to harbor Barrett's esophagus. The severity of symptoms in women is significantly more than in men and may contribute to earlier disease recognition and different disease management.