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Brenda Goodman, MA
Laura J. Martin, MD
Oct. 18, 2011 -- Men and women experience symptoms of heartburn and acid reflux differently, a new study shows.
The study is published in the Archives of Surgery.
Researchers surveyed nearly 3,000 Australian adults living in the community and more than 2,000 men and women who were having surgery to correct their gastroesophageal reflux disease (GERD).
Both women in the community and those who were having surgery complained of more frequent and severe heartburn than men. They also reported having more trouble swallowing solid foods. They were also slightly more likely than men to be taking medication to treat their heartburn.
But when doctors looked at the characteristics of patients who came in for surgery, they found that men actually had more physical manifestations of acid reflux disease.
The men, who were about seven years younger than the female surgical patients, were more likely to have weak valves where the esophagus meets the stomach. Experts say that can be a problem people are born with, but it can also develop over time because of chronic acid exposure.
Men were also more like to have esophagitis or Barrett's esophagus. Both are changes to the muscular tube (the esophagus) that connects the throat to the stomach caused by chronic acid exposure. They can result in inflammation and ulcers. In some cases, Barrett's esophagus may progress to esophageal cancer.
Women were more likely to have a problem called a hiatal hernia, where the stomach pokes upward through a hole in the diaphragm. Hiatal hernias can be associated with heartburn.
Women going in for reflux surgery were also more likely to be obese than their male counterparts.
Experts say the findings could signal a couple of things.
The first is that men may be experiencing significant symptoms of heartburn and acid reflux but are less willing to seek help than women.
Researchers say that's a phenomenon that's been well documented in other areas of health, too.
"In general, I think, in medicine, males tend to underreport the severity of their symptoms," says Anthony Starpoli, MD, a gastroenterologist who is associate director of esophageal endotherapy at Lenox Hill Hospital in New York City. "So I don't think there's a gender difference in the actual sensory pathways."
He says the study may help to explain why four times as many men die of esophageal cancer than women.
"You have to ask the question: Why is it that middle-aged white males in our country seem to be afflicted with Barrett's esophagus and esophageal carcinoma and so forth? Maybe their stoic personalities have something to do with it," says Starpoli, who was not part of the study.
Indeed, so many men shy away from seeing doctors even for regular checkups that the federal Agency for Healthcare Research and Quality recently got involved, posting red signs on billboards and in malls that read: "This year thousands of men will die of stubbornness."
Other experts say the findings could also mean that different mechanical processes are more likely to be driving acid reflux in women compared to men.
"Gastroesophageal reflux disease really encompasses a lot of different disease processes," says Matthew Kroh, MD, an assistant professor of surgery at Cleveland Clinic's Lerner College of Medicine in Ohio.
Previous studies have found that women are less likely than men to be satisfied with the results of surgeries called fundoplications, where the upper stomach is wrapped around the lower part of the esophagus to help tighten the leaky valve.
Part of the reason for that, Kroh thinks, is that they may need a different kind of fix for their problem.
"I think the treatment for GERD needs to be tailored to the particular presentation of a patient," says Kroh, who was not involved in the research." This obviously focuses on sex, but I think there are going to be a whole slew of variables that really predict better outcomes for patients."
SOURCES:Chen, Z. Archives of Surgery, October 2011.Anthony Starpoli, MD, gastroenterologist; associate director of esophageal endotherapy, Lenox Hill Hospital, New York City.Matthew D. Kroh, MD, assistant professor of surgery, Lerner College of Medicine, Cleveland Clinic, Ohio.
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