Sex and age differences in upper abdominal symptoms in patients without organic disease

Upper abdominal symptoms are common, but sex- and age-related differences remain unclear. This study evaluated symptom characteristics and sex- and age-related differences after excluding organic disease using a validated questionnaire.

Outpatients undergoing upper gastrointestinal endoscopy from 2015 to 2022 were enrolled. Eligible patients were analyzed after predefined exclusions. Symptoms were classified into reflux symptom (RS), postprandial distress syndrome-like (PDS-L), and epigastric pain syndrome-like (EPS-L) scores and compared between sexes and age strata. Multivariable linear regression analyses assessed associations of sex, age, BMI, and H. pylori infection status with these scores.

Of 52,598 cases, 7,519 patients were analyzed. The most common symptoms were bloating, postprandial fullness, and belching. Females had higher scores for 13 of 14 symptom items, except for the acid reflux item. In contrast, the RS score, calculated from seven reflux-related items, was higher in females. PDS-L and EPS-L scores were higher in females, and all three scores decreased with age. In multivariable analyses, female sex and younger age were independently associated with higher RS, PDS-L, and EPS-L scores. BMI was negatively associated with PDS-L and EPS-L scores, whereas H. pylori infection status was not associated with any of these scores.

Upper abdominal symptoms were more severe in females, except for the acid reflux item. The RS, PDS-L, and EPS-L scores declined with age and remained higher in females across most age groups. These findings suggest that sex and age should be considered when interpreting upper abdominal symptom scores in routine clinical practice.