Sex-Gender Differences in Irritable Bowel Syndrome

Abstract

Because of the sex-gender differences that are shown in a diversity of physiological and psychological factors, it can be speculated that the clinical presentation of symptoms as well as treatment strategies in women and men with irritable bowel syndrome (IBS) may differ. Studies have revealed that IBS is more common in women than men. As for the IBS subtype, IBS with constipation is significantly more prevalent among women than men. Sex hormones and gender differences may play important roles in the pathophysiology of IBS. However, its pathophysiologic mechanisms still remain largely unknown, and therapeutic implications are limited. Moreover, women IBS patients have been reported to feel more fatigue, depression, anxiety, and lower quality of life than men IBS patients. Furthermore, there has been evidence of differences in the appropriate treatment efficacy to IBS in men and women, although relatively few men are enrolled in most relevant clinical trials. A more sex-gender-oriented approach in the medical care setting could improve understanding of heterogeneous patients suffering from IBS. An individualized and multicomponent approach including sex and gender issues might help improve the treatment of IBS.

Keywords: Gender; Hormones; Irritable bowel syndrome; Sex.

Figure 1

Flow chart documenting the results of the search strategy.

Figure 2

Brain-gut axis and sex hormones interaction in irritable bowel syndrome (IBS). Sex hormones influence peripheral and central regulatory mechanisms involved in the pathophysiology of IBS contributing to the alterations in stress response, visceral sensitivity and motility, intestinal barrier function, and immune activation of intestinal mucosa. Sex hormones also have direct effects on the gut microbiota and enteric nervous system. E, estradiol; T, testosterone; P, progesterone; CRH, corticotropin-releasing hormone; ACTH, adrenocorticotropic hormone; GTP, guanosine-5’-triphosphate; CCK, cholecystokinin; PG, prostaglandin; 5-HT, 5-hydroxytryptamine; ER, estrogen receptor; DRG, dorsal root ganglion; JAM, junctional adhesion molecule. Adapted from Meleine and Matricon.