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Gender-Medizin bei chronisch entzündlicher Darmerkrankung

Ist das von Bedeutung?

Gender-specific medicine in chronic inflammatory bowel disease

Is it relevant?

  • Schwerpunkt
  • Published:
Die Gastroenterologie Aims and scope

Zusammenfassung

Auch heute noch werden geschlechtsspezifische Unterschiede in Bezug auf Genetik, Krankheitsphänotyp und Behandlungsmodalitäten bei chronisch entzündlicher Darmerkrankung (CED) in der Praxis zu wenig berücksichtigt. Dies ist insbesondere von Bedeutung für die Therapieadhärenz und das Auftreten von Komplikationen. Die Relevanz des Geschlechts zeigt sich auch im Hinblick auf die Interpretation von Studiendaten. Mögliche Faktoren für die Begünstigung einer CED sind eine Antibiotikaexposition bei Jungen oder eine Appendektomie bei Frauen. Bei positiver Familienanamnese für eine CED sind Frauen mit größerer Wahrscheinlichkeit betroffen als bei sporadischen Fällen. Das geschlechtsspezifische Auftreten von extraintestinalen Manifestationen ist gut belegt. Sowohl beim M. Crohn (MC) als auch bei der Colitis ulcerosa (CU) kommt es bei Frauen eher zu einer verzögerten Diagnosestellung und zu Fehldiagnosen als bei Männern. Allerdings weisen Männer mit CED ein höheres Risiko auf, an einem kolorektalen Karzinom zu erkranken, als Frauen mit CED. Bei der medikamentösen Therapie ergaben Studien, dass Männer sowohl bei MC als auch bei CU häufiger mit immunsuppressiven Medikamenten oder mit Biologika behandelt wurden als Frauen. Depressionen, Angststörungen, Essstörungen und sexuelle Funktionsstörungen kommen zwar auch bei männlichen CED-Patienten vor, werden aber bei Frauen wesentlich häufiger diagnostiziert.

Abstract

Gender-specific differences in genetics, disease phenotype, and treatment modalities in chronic inflammatory bowel disease (IBD) are still not sufficiently taken into account in practice. This is particularly important for treatment adherence and the occurrence of complications. The relevance of gender is also evident in the interpretation of study data. Possible predisposing factors for IBD are antibiotic exposure in boys or appendectomy in women. If there is a positive family history of IBD, women are more likely to be affected than sporadic cases. The gender-specific development of extraintestinal manifestations is well documented. In both Crohnʼs disease (MC) and ulcerative colitis (UC), women are more likely to be diagnosed late or misdiagnosed compared to men. However, men with IBD have a higher risk of developing colorectal cancer than women with IBD. In terms of drug therapy, studies have shown that men are treated with immunosuppressive drugs or biologics more often than women for both MC and IBD. Although depression, anxiety disorders, eating disorders and sexual dysfunction also occur in male IBD patients, they are diagnosed much more frequently in women.

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  1. Medizinische Klinik mit Schwerpunkt Gastroenterologie, Infektiologie, Rheumatologie, Charité – Universitätsmedizin Berlin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    Elena Sonnenberg

  2. Medizinische Klinik 1, Universitätsklinikum Frankfurt am Main, Goethe-Universität Frankfurt, Frankfurt, Deutschland

    Alica Kubesch-Grün

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Correspondence to Elena Sonnenberg.

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E. Sonnenberg weist auf folgende Beziehungen hin. Beratung: Abbvie, Janssen; Vortragshonorare: Biogen, Dr. Falk Pharma, Janssen, Abbvie, Takeda, BMS, Celltrion, CED Service GmbH. A. Kubesch-Grün: Beratungs- und Vortragshonorare von Takeda, Janssen-Cilag, Celgene/BMS GmbH, AbbVie und Galapagos.

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Irina Blumenstein, Frankfurt am Main

Sebastian Zundler, Erlangen

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Der Verlag bleibt in Hinblick auf geografische Zuordnungen und Gebietsbezeichnungen in veröffentlichten Karten und Institutsadressen neutral.

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Sonnenberg, E., Kubesch-Grün, A. Gender-Medizin bei chronisch entzündlicher Darmerkrankung. Gastroenterologie 18, 455–463 (2023). https://doi.org/10.1007/s11377-023-00738-8

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