Are there gender-specific differences in reflux disease and Barrett's oesophagus?

Studies of the prevalence of gastroesophageal reflux disease (GERD) have reported that male gender is an independent risk factor, especially for erosive reflux disease (ERD). Non-erosive GERD (NERD) is more common in women. The prevalence and severity of reflux symptoms are found more often in older women. In men, the peak is found between 50 and 70 years and decreases thereafter. The gender effect may be due to differences in parietal cell mass between males and females but has not been investigated extensively so far. Barrett's esophagus (BE) is a major complication of gastroesophageal reflux disease and is associated with a 30-125 times increased risk of developing carcinoma. Different studies have found the male gender to be predominantly associated with esophageal adenocarcinoma and BE. Additionally, there exists an age shift between females and males of 20 years, which shows age-specific prevalence curves for males between 20 and 59 years. The reasons for these gender-specific differences are largely unknown so far. Male predominance for ERD as a precursor of BE may explain the greater male/female sex ratio for BE. It is speculated that female sex hormones may play a protective role in the onset of BE. Knowledge of gender-specific differences in reflux disease and BE may be helpful for improving surveillance and screening strategies, although distinct recommendations are lacking so far. (C) 2010 WPMH GmbH. Published by Elsevier Ireland Ltd.