Colon to Rectum
Clin Gastroenterol Hepatol. 2024;22(11):2280-2290
Sex-related differences in the phenotype and course of inflammatory bowel disease: SEXEII study of ENEIDA
Background and aims: The impact of patient sex on the presentation of inflammatory bowel disease (IBD) has been poorly evaluated. The present study aimed to assess potential disparities in IBD phenotype and progression between sexes.
Methods: The authors performed an observational multicenter study that included patients with Crohn’s disease (CD) or ulcerative colitis from the Spanish Estudio Nacional en Enfermedad Inflamatoria intestinal sobre Determinantes genéticos y Ambientales registry. Data extraction was conducted in July 2021.
Results: A total of 51,595 patients with IBD were included, 52% were males and 25,947 had CD. The median follow-up period after diagnosis was 9 years in males and 10 years in females. In CD, female sex was an independent risk factor for medium disease onset (age, 17–40 y) (relative risk ratio [RR] = 1.45; 95% confidence interval [CI]: 1.31–1.62), later disease onset (age, > 40 y) (relative RR = 1.55; 95% CI: 1.38–1.73), exclusive colonic involvement (odds ratio [OR] = 1.24; 95% CI: 1.14–1.34), inflammatory behavior (OR = 1.14; 95% CI: 1.07–1.21), and extraintestinal manifestations (OR = 1.48; 95% CI: 1.38–1.59). However, female sex was a protective factor for upper gastrointestinal involvement (OR = 0.84; 95% CI: 0.79–0.90), penetrating behavior (OR = 0.76; 95% CI: 0.70–0.82), perianal disease (OR = 0.77; 95% CI: 0.71–0.82), and complications (OR = 0.73; 95% CI: 0.66–0.80). In ulcerative colitis, female sex was an independent risk factor for extraintestinal manifestations (OR = 1.48; 95% CI: 1.26–1.61). However, female sex was an independent protective factor for disease onset from age 40 onward (relative RR = 0.76; 95% CI: 0.66–0.87), left-sided colonic involvement (relative RR = 0.72; 95% CI: 0.67–0.78), extensive colonic involvement (relative RR = 0.59; 95% CI: 0.55–0.64), and abdominal surgery (OR = 0.78; 95% CI: 0.69–0.88).
Conclusions: There is sexual dimorphism in inflammatory bowel disease. The patient’s sex should be taken into account in the clinical management of the disease.