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Gender difference in gastro-esophageal reflux diseases.
- Source :
-
World journal of gastroenterology [World J Gastroenterol] 2016 Feb 07; Vol. 22 (5), pp. 1800-10. - Publication Year :
- 2016
-
Abstract
- The incidence of esophageal adenocarcinoma (EAC) has risen sharply in western countries over the past 4 decades. This type of cancer is considered to follow a transitional process that goes from gastro-esophageal reflux disease (GERD) to Barrett's esophagus (BE, a metaplastic condition of the distal esophagus), a precursor lesion and ultimately adenocarcinoma. This spectrum of GERD is strongly predominant in males due to an unidentified mechanism. Several epidemiologic studies have described that the prevalence of GERD, BE and EAC in women is closely related to reproductive status, which suggests a possible association with the estrogen level. Recently, we revealed in an in vivo study that the inactivation of mast cells by the anti-inflammatory function of estrogen may account for the gender difference in the GERD spectrum. Other studies have described the contribution of female steroid hormones to the gender difference in these diseases. Estrogen is reported to modulate the metabolism of fat, and obesity is a main risk factor of GERDs. Moreover, estrogen could confer esophageal epithelial resistance to causative refluxate. These functions of estrogen might explain the approximately 20-year delay in the incidence of BE and the subsequent development of EAC in women compared to men, and this effect may be responsible for the male predominance. However, some observational studies demonstrated that hormone replacement therapy exerts controversial effects in GERD patients. Nevertheless, the estrogen-related endocrine milieu may prevent disease progression toward carcinogenesis in GERD patients. The development of innovative alternatives to conventional acid suppressors may become possible by clarifying the mechanisms of estrogen.
- Subjects :
- Adenocarcinoma diagnosis
Adenocarcinoma metabolism
Adult
Aged
Alcohol Drinking adverse effects
Alcohol Drinking epidemiology
Barrett Esophagus diagnosis
Barrett Esophagus metabolism
Comorbidity
Disease Progression
Esophageal Neoplasms diagnosis
Esophageal Neoplasms metabolism
Estrogen Replacement Therapy adverse effects
Estrogens metabolism
Female
Gastroesophageal Reflux diagnosis
Gastroesophageal Reflux metabolism
Humans
Incidence
Life Style
Male
Middle Aged
Obesity epidemiology
Prevalence
Risk Assessment
Risk Factors
Sex Distribution
Sex Factors
Smoking adverse effects
Smoking epidemiology
Adenocarcinoma epidemiology
Barrett Esophagus epidemiology
Esophageal Neoplasms epidemiology
Gastroesophageal Reflux epidemiology
Health Status Disparities
Subjects
Details
- Language :
- English
- ISSN :
- 2219-2840
- Volume :
- 22
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- World journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 26855539
- Full Text :
- https://doi.org/10.3748/wjg.v22.i5.1800