Effect of Sex on Symptoms Associated With Gastroesophageal Reflux

Background: Previous research suggests that females have a poorer outcome than do males after surgery for gastroesophageal reflux. Objective: To evaluate reflux and esophageal symptoms in males and females in a community sample and in patients undergoing antireflux surgery. Design: Face-to-face interview. Setting: A South Australian community. Participants: Random sample of 2973 individuals from the community and 2153 patients presenting for antireflux surgery. Main Outcome Measures: In a random sample of 2973 individuals from the community, the prevalence of reflux and other esophageal symptoms was determined and compared with symptoms in 2153 patients presenting for antireflux surgery. Identical questions were used to assess frequency and severity of heartburn and dysphagia and medication use. Analog scales assessed heartburn and dysphagia (0 indicating no symptoms and 10, severesymptoms). Outcomes for males vs females were compared across both groups. Results: In the community, females were more likely to report heartburn, and when reported, symptom severity was higher. The prevalence of dysphagia was similar for males and females, although females reported higher dysphagia scores for solid foods.Asimilar proportion of males and females took antireflux medications. Females presenting for antireflux surgery were, on average, 7 years older than males, had a higher body mass index, and had higher heartburn and dysphagia symptom scores. At endoscopy, men were more likely to have ulcerative esophagitis and Barrett esophagus, and at surgery they were less likely to have a hiatal hernia. Conclusions: Significant differences were noted between males and females in the frequency and severity of gastroesophageal reflux-associated symptoms in the community and in patients presenting for surgery. These might reflect differences in symptom perception, which explain previously reported better outcomes in men undergoing antireflux surgery.