Men, women present differently for their reflux symptoms

Significant differences exist between how men and women experience symptoms of gastroesophageal reflux, and consequently, how they might present their diseases to their physicians.

Researchers conducted face-to-face interviews among a random sample of individuals from the community and from patients seeking surgery for reflux in South Australia in the fall of 2006. Patients ages 15 to 95 answered questions on frequency and severity of heartburn and dysphagia, as well as medication use. Outcomes in men and women were compared for the community-dwelling population and for preoperative surgical candidates. Results appeared in the October Archives of Surgery.

Of the 2,973 community-dwelling interviewees, 1,277 (43%) were men and 1,696 (57%) were women. Women were more likely to never report having heartburn than men (52.1% vs. 46.8%, P=0.005). However, women who had heartburn were more likely to report a heartburn score of 4 or higher (54.0% vs. 44.7%, P=0.01) on a scale of 0 (no symptoms) to 10 (severe symptoms), and the mean heartburn score was also higher in women. A similar proportion of men and women took medicine to control their symptoms.

Among the surgical population, women were an average of seven years older than men at the time of surgery, had a higher preoperative body mass index, and had higher preoperative symptom scores for heartburn and dysphagia. No differences were noted between the sexes for average esophageal acid exposure measured by 24-hour pH monitoring and manometrically measured esophageal peristalsis. Men were more likely to have ulcerative esophagitis and Barrett's esophagus, but at surgery, were less likely to have a hiatal hernia.

“These findings suggest that men present for surgery with more advanced reflux disease, although this does not result in men reporting more severe symptoms,” the researchers wrote. “The tendency to present with a higher grade of endoscopic esophagitis and lower resting LES (lower esophageal sphincter) pressure actually suggests that men present with more severe reflux disease, at least from the viewpoint of these objective measures of reflux.”

The researchers felt that the differences might be partly explained by differences in the way men and women handle health concerns.

“It is widely recognized that males tend to ignore symptoms of illness and are more reluctant to engage in preventive health measures than are females,” they wrote. “On the other hand, females probably take more interest in their health and might be more likely to report symptoms that many males might not worry about.”