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Sex- and Gender-Related Differences in Common Functional Gastroenterologic Disorders
Open accessAbstract
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 females296.”
From Sex and gender in neurodevelopmental conditions (2023) · cites this paper as [296]
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Metadata
- Authors
- Narayanan, S. P., Anderson, B., & Bharucha, A. E.
- Affiliations
- Mayo Clinic (US)
- Mercy Hospital (US)
- Corresponding author
- 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)
- PMC
- PMC8075061
- OpenAlex
- W3152161209
- Cited by
- 131
- References
- 158
- Citations by year
- 2026: 29 · 2025: 32 · 2024: 30 · 2023: 20 · 2022: 15 · 2021: 4
- FWCI
- 15.77
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- 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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