Adam, Eve and the reflux enigma: age and sex differences across the gastro-oesophageal reflux spectrum.
BACKGROUND
We present demographic differences across the gastro-oesophageal reflux disease (GORD) spectrum in a UK District General Hospital.


METHODS
Data were prospectively collected over 37 years. At endoscopy patients were categorized as: erosive oesophagitis (EO), Barrett's oesophagus (BO) or nonerosive reflux disease (NER). Analysis 1: comparison of EO, BO and NER 1977-2001 when the database for GORD without BO closed. Analysis 2: demographic differences in oesophageal adenocarcinoma (OAC) in total BO population diagnosed 1977-2011.


RESULTS
GORD 1977-2001 (n=11 944): sex, male predominance in EO and BO but not NER; male : female ratios, 1.81, 1.65, 0.87, respectively (P<0.0001); mean age at presentation, EO 54 years, BO 62 years, NER 50 years; women were older than men by 10, 7 and 6 years, respectively.BO 1977-2011: prevalent OAC, 87/1468 (6%); male : female ratio, 4.1 (P<0.0001); incident OAC, 54/1381 (3.9%); male : female ratio, 3.5 (P<0.0001). Among all BO, more men developed OAC (3 vs. 0.9%). Within each sex, proportion of OAC higher among men (4.9 vs. 2.3%); at OAC diagnosis women were slightly but not significantly older (69.9 vs. 72.3 years, P=0.322).


CONCLUSIONS
Two views may explain our findings. First, women have either milder reflux, or reduced mucosal sensitivity hence reflux remains silent for longer. Alternatively, women genuinely develop reflux later, that is, are more protected and for longer from developing GORD and its complications. Early evidence is emerging that female sex hormones may indeed have a protective role in GORD during the reproductive period. We suggest reflux and its consequences may be an example of 'protection' conferred on Eve.
Rotherham General Hospital, Rotherham, South Yorkshire, UK.
Christine
C
Royston
Karna D
KD
Bardhan
D000230:Adenocarcinoma / Q000175:diagnosis / Q000453:epidemiology*; D000328:Adult; D017677:Age Distribution; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology*; D016099:Endoscopy, Gastrointestinal; D004739:England / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology*; D054624:Health Status Disparities; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D065840:Protective Factors; D012307:Risk Factors; D017678:Sex Distribution; D013997:Time Factors