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Der Gastroenterologe

, Volume 14, Issue 2, pp 96–101 | Cite as

Gastroösophageale Refluxerkrankung und geschlechtsspezifische Unterschiede

  • M. Selgrad
  • M. Müller-Schilling
  • A. KandulskiEmail author
Schwerpunkt
  • 93 Downloads

Zusammenfassung

Die gastroösophageale Refluxerkrankung (GERD) stellt eines der häufigsten gastroenterologischen Krankheitsbilder dar und zeigt einen deutlichen Anstieg der Prävalenz in den letzten Jahren. In der Krankheitsausprägung und -entstehung existieren geschlechtsspezifische Unterschiede, die differenziert betrachtet werden sollten. Männer haben eine stärkere Ausbildung der GERD in Hinblick auf den Grad der Entzündung und den Säurereflux. Wahrscheinlich ist aus diesem Grund das Risiko für die Entwicklung eines Barrett-Ösophagus bei Männern etwa 2‑ bis  3-fach und für ein ösophageales Adenokarzinom sogar 3‑ bis  6-mal höher als bei Frauen. Dies unterstreicht die Notwendigkeit, geschlechtsspezifische Unterschiede der GERD besser zu verstehen, um Diagnostik, Therapie und Prävention zu optimieren.

Schlüsselwörter

GERD Barrett-Ösophagus Ösophaguskarzinom Gender 

Gastroesophageal reflux disease and gender-specific differences

Abstract

Gastroesophageal reflux disease (GERD) represents one of the most common gastrointestinal diseases and has shown a significant increase in prevalence in recent years. There are gender-specific differences in GERD both for disease characteristics and development of the disease. Men suffer from more severe reflux with a higher grade of inflammation and acid reflux. Most probably, this seems to be the underlying reason why men have a higher risk for the development of disease-associated complications like Barrett’s esophagus (approximately 2- to 3‑fold) and esophageal adenocarcinoma (3 to 6 times higher). This underlines the importance of better understanding the gender-specific differences of GERD in order to optimize patient care including prevention, diagnosis and treatment.

Keywords

GERD Barrett’s esophagus Esophageal cancer Gender 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Selgrad, M. Müller-Schilling und A. Kandulski geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Alvarez-Sánchez A, Rey E, Achem SR, Dı́az-Rubio M (1999) Does progesterone fluctuation across the menstrual cycle predispose to gastroesophageal reflux? Am J Gastroenterol 94:1468–1471.  https://doi.org/10.1016/S0002-9270(99)00184-7 CrossRefPubMedGoogle Scholar
  2. 2.
    Asanuma K, Iijima K, Shimosegawa T (2016) Gender difference in gastro-esophageal reflux diseases. World J Gastroenterol 22:1800.  https://doi.org/10.3748/wjg.v22.i5.1800 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Ashcroft GS, Dodsworth J, van Boxtel E et al (1997) Estrogen accelerates cutaneous wound healing associated with an increase in TGF-beta1 levels. Nat Med 3:1209–1215CrossRefGoogle Scholar
  4. 4.
    van Blankenstein M, Looman CW, Johnston BJ, Caygill CP (2005) Age and sex distribution of the prevalence of Barrett’s esophagus found in a primary referral endoscopy center. Am J Gastroenterol 100:568–576.  https://doi.org/10.1111/j.1572-0241.2005.40187.x CrossRefPubMedGoogle Scholar
  5. 5.
    Bosetti C, Levi F, Ferlay J et al (2008) Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer 122:1118–1129.  https://doi.org/10.1002/ijc.23232 CrossRefPubMedGoogle Scholar
  6. 6.
    Cappell MS (1998) The safety and efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am 27:37–71CrossRefGoogle Scholar
  7. 7.
    Cook MB, Wild CP, Forman D (2005) A systematic review and Meta-analysis of the sex ratio for Barrett’s esophagus, erosive reflux disease, and nonerosive reflux disease. Epidemiol Rev 162:1050–1061.  https://doi.org/10.1093/aje/kwi325 CrossRefGoogle Scholar
  8. 8.
    Corley DA (2007) Obesity and the rising incidence of oesophageal and gastric adenocarcinoma: what is the link? Gut 56:1493–1494.  https://doi.org/10.1136/gut.2007.124255 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Corley DA, Kubo A, Levin TR et al (2007) Abdominal obesity and body mass index as risk factors for Barrett’s esophagus. Baillieres Clin Gastroenterol 133:34–41.  https://doi.org/10.1053/j.gastro.2007.04.046 CrossRefGoogle Scholar
  10. 10.
    Derakhshan MH, Liptrot S, Paul J et al (2009) Oesophageal and gastric intestinal-type adenocarcinomas show the same male predominance due to a 17 year delayed development in females. Gut 58:16–23.  https://doi.org/10.1136/gut.2008.161331 CrossRefPubMedGoogle Scholar
  11. 11.
    El-Serag HB, Hashmi A, Garcia J et al (2014) Visceral abdominal obesity measured by CT scan is associated with an increased risk of Barrett’s oesophagus: a case-control study. Gut 63(220):2–229.  https://doi.org/10.1136/gutjnl-2012-304189 CrossRefGoogle Scholar
  12. 12.
    El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 63:871–880.  https://doi.org/10.1136/gutjnl-2012-304269 CrossRefPubMedGoogle Scholar
  13. 13.
    Endlicher E, Gelbmann C, Messmann H (2009) Refluxerkrankung und Barrett-Ösophagus – Gibt es geschlechtsspezifische Unterschiede? Z Gastroenterol 47:1065–1068.  https://doi.org/10.1055/s-0028-1109331 CrossRefPubMedGoogle Scholar
  14. 14.
    Eusebi LH, Ratnakumaran R, Yuan Y et al (2018) Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis. Gut 67:430–440.  https://doi.org/10.1136/gutjnl-2016-313589 CrossRefPubMedGoogle Scholar
  15. 15.
    Falk GW, Thota PN, Richter JE et al (2005) Barrett’s esophagus in women: demographic features and progression to high-grade dysplasia and cancer. Clin Gastroenterol Hepatol 3:1089–1094CrossRefGoogle Scholar
  16. 16.
    Fass R, Ofman JJ (2002) Gastroesophageal reflux disease-should we adopt a new conceptual framework? Am J Gastroenterol 97:1901–1909.  https://doi.org/10.1111/j.1572-0241.2002.05912.x CrossRefPubMedGoogle Scholar
  17. 17.
    Flegal KM, Carroll MD, Kit BK, Ogden CL (2012) Prevalence of obesity and trends in the distribution of body mass index among US adults. JAMA 307(491):1999–2010.  https://doi.org/10.1001/jama.2012.39 CrossRefGoogle Scholar
  18. 18.
    Ford AC, Forman D, Reynolds PD et al (2005) Ethnicity, gender, and socioeconomic status as risk factors for esophagitis and Barrett’s esophagus. Epidemiol Rev 162:454–460.  https://doi.org/10.1093/aje/kwi218 CrossRefGoogle Scholar
  19. 19.
    Ford ES, Li C, Zhao G, Tsai J (2011) Trends in obesity and abdominal obesity among adults in the United States from 1999–2008. Int J Obes Relat Metab Disord 35:736–743.  https://doi.org/10.1038/ijo.2010.186 CrossRefGoogle Scholar
  20. 20.
    Green J, Czanner G, Reeves G et al (2012) Menopausal hormone therapy and risk of gastrointestinal cancer: Nested case-control study within a prospective cohort, and meta-analysis. Int J Cancer 130:2387–2396.  https://doi.org/10.1002/ijc.26236 CrossRefPubMedGoogle Scholar
  21. 21.
    Grishina I, Fenton A, Sankaran-Walters S (2014) Gender differences, aging and hormonal status in mucosal injury and repair. Aging Dis 5:160–169.  https://doi.org/10.14336/AD.2014.0500160 CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Hampel H, Abraham NS, El-Serag HB (2005) Meta-analysis: obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 143:199–211CrossRefGoogle Scholar
  23. 23.
    Hvid-Jensen F, Pedersen L, Drewes AM et al (2011) Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med 365:1375–1383.  https://doi.org/10.1056/NEJMoa1103042 CrossRefGoogle Scholar
  24. 24.
    Jaspersen D, Kulig M, Labenz J et al (2003) Prevalence of extra-oesophageal manifestations in gastro-oesophageal reflux disease: an analysis based on the ProGERD Study. Aliment Pharmacol Ther 17:1515–1520CrossRefGoogle Scholar
  25. 25.
    Kandulski A, Moleda L, Müller-Schilling M (2018) Diagnostic investigations of gastroesophageal reflux disease: who and when to refer and for what test? Visc Med 34:97–100.  https://doi.org/10.1159/000488184 CrossRefPubMedGoogle Scholar
  26. 26.
    Katz PO, Gerson LB, Vela MF (2013) Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 108:308–328.  https://doi.org/10.1038/ajg.2012.444 CrossRefPubMedGoogle Scholar
  27. 27.
    Koelz HR, Blum AL, Modlin IM (2003) Costs of gerd: facts and fiction. Baillieres Clin Gastroenterol 125:981–982Google Scholar
  28. 28.
    Koop H, Fuchs K, Labenz J et al (2014) S2k-Leitlinie: Gastroösophageale Refluxkrankkheit unter Federführung der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 52:1299–1346.  https://doi.org/10.1055/s-0034-1385202 CrossRefPubMedGoogle Scholar
  29. 29.
    Kulig M, Leodolter A, Vieth M et al (2003) Quality of life in relation to symptoms in patients with gastro-oesophageal reflux disease—an analysis based on the ProGERD initiative. Aliment Pharmacol Ther 18:767–776CrossRefGoogle Scholar
  30. 30.
    Lagergren J, Nyrén O (1998) Do sex hormones play a role in the etiology of esophageal adenocarcinoma? A new hypothesis tested in a population-based cohort of prostate cancer patients. Cancer Epidemiol Biomarkers Prev 7:913–915PubMedGoogle Scholar
  31. 31.
    do Rosário Dias de Oliveira Latorre M, Medeiros da Silva A, Chinzon D et al (2014) Epidemiology of upper gastrointestinal symptoms in Brazil (EpiGastro): a population-based study according to sex and age group. World J Gastroenterol 20:17388.  https://doi.org/10.3748/wjg.v20.i46.17388 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lepage C, Rachet B, Jooste V et al (2008) Continuing rapid increase in esophageal adenocarcinoma in England and Wales. Am J Gastroenterol 103:2694–2699.  https://doi.org/10.1111/j.1572-0241.2008.02191.x CrossRefPubMedGoogle Scholar
  33. 33.
    Lin M, Gerson LB, Lascar R et al (2004) Features of gastroesophageal reflux disease in women. Am J Gastroenterol 99:1442–1447.  https://doi.org/10.1111/j.1572-0241.2004.04147.x CrossRefPubMedGoogle Scholar
  34. 34.
    Macfie AG, Magides AD, Richmond MN, Reilly CS (1991) Gastric emptying in pregnancy. Br J Anaesth 67:54–57CrossRefGoogle Scholar
  35. 35.
    Malfertheiner S, Seelbach-Göbel B (2015) Die gastroösophageale Refluxkrankheit in der Schwangerschaft. Frauenheilkd Up2date 9:257–273.  https://doi.org/10.1055/s-0033-1358162 CrossRefGoogle Scholar
  36. 36.
    Malfertheiner SF, Malfertheiner MV, Kropf S et al (2012) A prospective longitudinal cohort study: evolution of GERD symptoms during the course of pregnancy. BMC Gastroenterol 12:131.  https://doi.org/10.1186/1471-230X-12-131 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Massl R, van Blankenstein M, Jeurnink S et al (2014) Visceral adipose tissue: the link with esophageal adenocarcinoma. Scand J Gastroenterol 49:449–457.  https://doi.org/10.3109/00365521.2013.873818 CrossRefPubMedGoogle Scholar
  38. 38.
    Menon S, Jayasena H, Nightingale P, Trudgill NJ (2011) Influence of age and sex on endoscopic findings of gastrooesophageal reflux disease: an endoscopy database study. Eur J Gastroenterol Hepatol 23:389–395.  https://doi.org/10.1097/MEG.0b013e328345d429 CrossRefPubMedGoogle Scholar
  39. 39.
    Menon S, Nightingale P, Trudgill N (2014) Is hormone replacement therapy in post-menopausal women associated with a reduced risk of oesophageal cancer? United European Gastroenterol J 2:374–382.  https://doi.org/10.1177/2050640614543736 CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Nasseri-Moghaddam S, Mofid A, Ghotbi M‑H et al (2008) Epidemiological study of gastro-oesophageal reflux disease: reflux in spouse as a risk factor. Aliment Pharmacol Ther 28:144–153.  https://doi.org/10.1111/j.1365-2036.2008.03708.x CrossRefPubMedGoogle Scholar
  41. 41.
    Nguyen P, Lee SD, Castell DO (1995) Evidence of gender differences in esophageal pain threshold. Am J Gastroenterol 90:901–905PubMedGoogle Scholar
  42. 42.
    Nilsson M, Johnsen R, Ye W et al (2003) Obesity and estrogen as risk factors for gastroesophageal reflux symptoms. JAMA 290:66.  https://doi.org/10.1001/jama.290.1.66 CrossRefPubMedGoogle Scholar
  43. 43.
    Peery AF, Dellon ES, Lund J et al (2012) Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology 143:1179–1187.e3.  https://doi.org/10.1053/j.gastro.2012.08.002 CrossRefPubMedPubMedCentralGoogle Scholar
  44. 44.
    Pohl H, Wrobel K, Bojarski C et al (2013) Risk factors in the development of esophageal adenocarcinoma. Am J Gastroenterol 108:200–207.  https://doi.org/10.1038/ajg.2012.387 CrossRefPubMedGoogle Scholar
  45. 45.
    Rey E, Moreno-Elola-Olaso C, Artalejo FR et al (2006) Association between weight gain and symptoms of gastroesophageal reflux in the general population. Am J Gastroenterol 101:229–233.  https://doi.org/10.1111/j.1572-0241.2006.00412.x CrossRefPubMedGoogle Scholar
  46. 46.
    Richter JE (2005) Review article: the management of heartburn in pregnancy. Aliment Pharmacol Ther 22:749–757.  https://doi.org/10.1111/j.1365-2036.2005.02654.x CrossRefPubMedGoogle Scholar
  47. 47.
    Richter JE, Rubenstein JH (2018) Presentation and Epidemiology of Gastroesophageal Reflux Disease. Baillieres Clin Gastroenterol 154:267–276.  https://doi.org/10.1053/j.gastro.2017.07.045 CrossRefGoogle Scholar
  48. 48.
    Royston C, Bardhan KD (2017) Adam, Eve and the reflux enigma: age and sex differences across the gastro-oesophageal reflux spectrum. Eur J Gastroenterol Hepatol 29:634–639.  https://doi.org/10.1097/MEG.0000000000000845 CrossRefPubMedGoogle Scholar
  49. 49.
    Sandhu DS, Fass R (2018) Current trends in the management of Gastroesophageal Reflux Disease. Gut Liver 12:7–16.  https://doi.org/10.5009/gnl16615 CrossRefPubMedGoogle Scholar
  50. 50.
    Savas N (2014) Gastrointestinal endoscopy in pregnancy. World J Gastroenterol 20:15241–15252.  https://doi.org/10.3748/wjg.v20.i41.15241 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Shaheen NJ, Hansen RA, Morgan DR et al (2006) The burden of gastrointestinal and liver diseases, 2006. Am J Gastroenterol 101:2128–2138.  https://doi.org/10.1111/j.1572-0241.2006.00723.x CrossRefPubMedGoogle Scholar
  52. 52.
    van Soest EM, Dieleman JP, Siersema PD et al (2005) Increasing incidence of Barrett’s oesophagus in the general population. Gut 54:1062–1066.  https://doi.org/10.1136/gut.2004.063685 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Van Thiel DH, Wald A (1981) Evidence refuting a role for increased abdominal pressure in the pathogenesis of the heartburn associated with pregnancy. Am J Obstet Gynecol 140:420–422CrossRefGoogle Scholar
  54. 54.
    Thrift AP, Whiteman DC (2012) The incidence of esophageal adenocarcinoma continues to rise: analysis of period and birth cohort effects on recent trends. Ann Oncol 23:3155–3162.  https://doi.org/10.1093/annonc/mds181 CrossRefPubMedGoogle Scholar
  55. 55.
    Vakil N, van Zanten SV, Kahrilas P et al (2006) The montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 101:1900–1920.  https://doi.org/10.1111/j.1572-0241.2006.00630.x CrossRefPubMedGoogle Scholar
  56. 56.
    Vega KJ, Langford-Legg T, Palacio C et al (2013) Females without reflux symptoms or gastroesophageal reflux disease have less distal esophageal acid exposure than males without reflux symptoms or gastroesophageal reflux disease. Dis Esophagus 26:246–249.  https://doi.org/10.1111/j.1442-2050.2012.01367.x CrossRefPubMedGoogle Scholar
  57. 57.
    Voutilainen M (2008) Epidemiological trends in oesophageal cancer in the Nordic countries. Scand J Gastroenterol 43:323–327CrossRefGoogle Scholar
  58. 58.
    Wiklund I (2004) Review of the quality of life and burden of illness in gastroesophageal reflux disease. Dig Dis 22:108–114.  https://doi.org/10.1159/000080308 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  • M. Selgrad
    • 1
  • M. Müller-Schilling
    • 1
  • A. Kandulski
    • 1
    Email author
  1. 1.Klinik und Poliklinik für Innere Medizin IUniversitätsklinikum RegensburgRegensburgDeutschland

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