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

Narayanan, Susrutha Puthanmadhom; Anderson, Bradley; Bharucha, Adil E.

doi:10.1016/j.mayocp.2020.10.004

Cited by 131Gastrointestinal motility and disordersPsychosomatic Disorders and Their TreatmentsGut microbiota and health

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

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Narayanan, Susrutha Puthanmadhom, Anderson, Bradley, Bharucha, Adil E.·2021·Mayo Clinic Proceedings

DOI 10.1016/j.mayocp.2020.10.004PMC PMC8075061

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Abstract

Functional gastrointestinal (GI) disorders (FGIDs) result from central and peripheral mechanisms, cause chronic remitting-relapsing symptoms, and are associated with comorbid conditions and impaired quality of life. This article reviews sex- and gender-based differences in the prevalence, pathophysiologic factors, clinical characteristics, and management of functional dyspepsia (FD) and irritable bowel syndrome (IBS) that together affect approximately 1 in 4 people in the United States. These conditions are more common in women. Among patients with IBS, women are more likely to have severe symptoms and coexistent anxiety or depression; constipation or bloating and diarrhea are more common in women and men, respectively, perhaps partly because defecatory disorders, which cause constipation, are more common in women. Current concepts suggest that biological disturbances (eg, persistent mucosal inflammation after acute gastroenteritis) interact with other environmental factors (eg, abuse) and psychological stressors, which influence the brain and gut to alter GI tract motility or sensation, thereby causing symptoms. By comparison to a considerable understanding of sex-based differences in the pathogenesis of visceral hypersensitivity in animal models, we know less about the contribution of these differences to FGID in humans. Slow gastric emptying and colon transit are more common in healthy women than in men, but effects of gonadal hormones on colon transit are less important than in rodents. Although increased visceral sensation partly explains symptoms, the effects of sex on visceral sensation, colonic permeability, and the gut microbiome are less prominent in humans than rodents. Whether sex or gender affects response to medications or behavioral therapy in FD or IBS is unclear because most patients in these studies are women.

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In the general population, some gastrointestinal disorders are more common in males (for example, diarrhoea) and some are more common in females (for example, functional dyspepsia and irritable bowel syndrome); they are also more often associated with anxiety and depression in females.
“In the general population, some gastrointestinal disorders are more common in males (for example, diarrhoea) and some are more common in females (for example, functional dyspepsia and irritable bowel syndrome); they are also more often associated with anxiety and depression in females296.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [296]

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Sex and gender in neurodevelopmental conditions
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Crisis in the gut: navigating gastrointestinal challenges in Gulf War Illness with bioengineering
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Can transcutaneous electrical acupoint stimulation prevent postoperative nausea and vomiting?
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Patient Experience, Gender, Age, Race, and Social Determinants of Health
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First characterization of the intestinal microbiota in healthy Tunisian adults using 16S rRNA gene sequencing
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Most patients with disorders of gut‐brain interaction receive pharmacotherapy with major or moderate drug‐gene interactions
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Overweight/obesity and gastrointestinal disease incidence in Denmark—a cohort study
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Pharmacokinetic and safety profile of PT109B, a novel multi-targeted compound against Alzheimer's disease
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Yoga and Naturopathy intervention on psychological comorbidities and autonomic function for irritable bowel syndrome patient: A case study
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Extra Virgin Olive Oil Reduces the Risk of Non-Alcoholic Fatty Liver Disease in Females but Not in Males: Results from the NUTRIHEP Cohort
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The lipidome of posttraumatic stress disorderPreprint
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A Gender Perspective on Coloproctological Diseases: A Narrative Review on Female Disorders
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Prevalence of gastroparesis symptoms and its associated factors among type 2 diabetes mellitus patients in West Bank in Palestine: a national cross-sectional study
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Does Poultry Consumption Increase the Risk of Mortality for Gastrointestinal Cancers? A Preliminary Competing Risk Analysis
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The Association Between Ultra‐Processed Foods Consumption and Disorders of Gut–Brain Interaction: The Isfahan Functional Disorders ( ISFUN ) Study
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Sex-specific difference on anxiety- and depressive-like behavior in neuronal growth regulator 1-knockout mice
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Cross-national pharmacovigilance of drug-induced intestinal obstruction: disproportionality signals in FAERS and external validation in JADER
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Prevalence of opioid-induced constipation in the emergency department: a retrospective study
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A CNS circuit that regulates gut motility
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Particulate matter exposure may increase the risk of irritable bowel syndrome: a large-scale prospective study based on the UK Biobank
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Menthacarin treatment attenuates nociception in models of visceral hypersensitivity
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Overlap Between Gastroesophageal Reflux Disease and Functional Constipation and Associated Risk Factors Among the General Population in Saudi Arabia
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The Possible Effects of Common Air Pollutants on the Pathophysiology of Functional Gastrointestinal Disorders: A Narrative Review
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Gastrointestinal System Symptoms, Psychological Resilience, Emotional Self-Efficacy, and Healthy Living Behaviors in Patients Scheduled for Endoscopy/Colonoscopy
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Sex-Dependent Differences in the Elemental Composition of Internal Organs Determined via Total Reflection X-Ray Fluorescence and Inductively Coupled Plasma Optical Emission Spectroscopy
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Development of Novel Symptom Score to Assist in Screening for Exocrine Pancreatic Insufficiency
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Gastrointestinal Disorders: Inflammatory Bowel Disease and Irritable Bowel Syndrome
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A qualitative exploration into the lived experiences of females with a gastrointestinal condition
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Studying the Role of Myenteric Amyloidosis in Gastrointestinal Dysmotility and Enteric Neural Dysfunction Using APP / PS1 Mice—Is It an Adequate Animal Model?
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No Evidence for Unconscious Attentional Bias in People With Clinically Significant Symptoms of Functional Gastrointestinal Disorders: A Study Using the Emerging Electroencephalographic Paradigm of Fast Periodic Visual Stimulation
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Authors: Narayanan, S. P., Anderson, B., & Bharucha, A. E.
Affiliations: Mayo Clinic (US)
Mercy Hospital (US)
Corresponding author: Bharucha, Adil E.
ORCID: Anderson, Bradley
Bharucha, Adil E.
Venue: Mayo Clinic Proceedings
Publisher: Elsevier BV
Published: 2021-04
Volume: 96
Issue: 4
Pages: 1071-1089
ISSN: 0025-6196 (ISSN-L)
DOI: 10.1016/j.mayocp.2020.10.004
PMC: PMC8075061
OpenAlex: W3152161209
Cited by: 131
References: 158
Citations by year: 2026: 29 · 2025: 32 · 2024: 30 · 2023: 20 · 2022: 15 · 2021: 4 · 2017: 1
FWCI: 15.77
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Mayo Clinic Proceedings (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
Keywords: functional gastrointestinal disorders, functional dyspepsia, irritable bowel syndrome, sex differences, gender differences, women, visceral hypersensitivity, visceral sensation, colonic transit, gastric emptying, gonadal hormones, comorbid depression and anxiety, defecation disorders, gut microbiota, colonic permeability, pathogenesis, treatment response
MeSH terms: Adult, Aged, Aged, 80 and over, Female, Gastrointestinal Diseases, Humans, Male, Middle Aged, Severity of Illness Index, Sex Factors, United States, Prevalence

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

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