Aysis Ahmad, MD

Men and women are not created equal when it comes to GI disorders. Hormonal and anatomic differences play roles in disease risk and development. Even the endoscopist’s gender can make a difference.

“Many patients, especially women, prefer an endoscopist of the same gender,” said Aysis Ahmad, MD, associate professor of gastroenterology and hepatology at Drexel University College of Medicine, Philadelphia, PA. “And endoscopists with smaller hands can have a harder time manipulating endoscopes. We need smaller handles.”

Dr. Ahmad discussed sex-based differences in GI disorders on Saturday during an AGA Postgraduate Course breakout session. Gastroenterologists who believe that women are more likely to pose technical challenges are correct, she said. Women have longer colons than men and also tend to have a narrower pelvis into which the transverse colon dips.

“Improved prep, anesthesia adjustments and the use of pediatric or upper scopes usually helps,” Dr. Ahmad said. “So can water immersion, balloon-assisted devices, using a cap to maneuver the narrowed sigmoid and a Trendelenburg position to help get through the sigmoid.”
Sex hormones can play major roles in Barrett’s esophagus, gastroesophageal reflux disease, irritable bowel syndrome (IBS), Crohn’s and other conditions, Dr. Ahmad added.

Estrogen receptors amplify visceral pain signals while testosterone can have an analgesic effect. Women are more likely to have non-erosive reflux disease than men, but show similar rates of Barrett’s about 20 years older than men as the protective effects of estrogen wane with menopause.

Women show a similar lag in the development of adenocarcinoma of the esophagus and gastric cancers.

IBS affects women 1.7 times more than men, but symptoms differ between the sexes, Dr. Ahmad said. Women are more likely to have constipation, bloating, nausea, anxiety or depression, extra-intestinal pain syndromes and lower quality of life. Men more often have diarrhea and higher stool frequency.

Credit hormonal differences, Dr. Ahmad said. Fluctuations in estrogen with menses triggers symptoms in women.

Women with IBS should also be evaluated for endometriosis and ovarian cancer.

“Women with stage 1 and 2 ovarian cancer do exhibit symptoms, they just aren’t recognized,” she said. “Carefully evaluate women to be sure they don’t have endometriosis or ovarian cancer. “