Sex- and Gender-Related Differences in Common Functional Gastroenterologic Disorders

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Sex and Gender in Medicine

Background:

• Functional gastrointestinal disorders (FGIDs), including functional dyspepsia (FD) and irritable bowel syndrome (IBS), affect approximately 25% of the US population.
• These conditions are characterized by chronic, relapsing symptoms, comorbid conditions, and reduced quality of life, stemming from central and peripheral mechanisms.
• Women exhibit higher prevalence and distinct clinical characteristics for FGIDs compared to men.

Purpose of the Study:

• To review and synthesize current knowledge on sex- and gender-based differences in the prevalence, pathophysiology, clinical presentation, and management of FD and IBS.
• To highlight the current understanding and gaps in knowledge regarding the influence of sex and gender on FGID pathogenesis and treatment response.

Main Methods:

• Literature review focusing on studies examining sex and gender in functional gastrointestinal disorders.
• Analysis of epidemiological data, pathophysiological mechanisms, clinical manifestations, and treatment outcomes in FD and IBS.
• Comparison of findings across human studies and relevant animal models.

Main Results:

• FGIDs are more common in women, who are more likely to experience severe IBS symptoms, anxiety, or depression.
• While slow gastric emptying and colon transit are more common in women, the influence of gonadal hormones and sex differences in visceral sensation, gut permeability, and microbiome are less pronounced in humans than in rodents.
• Defecatory disorders contributing to constipation are more prevalent in women.

Conclusions:

• Sex and gender significantly influence the prevalence and presentation of FGIDs, particularly IBS and FD.
• While some physiological differences exist between sexes, their contribution to FGID pathogenesis in humans requires further investigation, especially compared to animal models.
• The impact of sex and gender on treatment efficacy for FD and IBS remains unclear due to underrepresentation of men in clinical trials.