Sex-Related Differences in the Phenotype and Course of Inflammatory Bowel Disease: SEXEII Study of ENEIDA

• Published in: Clinical gastroenterology and hepatology Vol. 22; no. 11; pp. 2280 - 2290
• Main Authors: Gargallo-Puyuelo, Carla J., Ricart, Elena, Iglesias, Eva, de Francisco, Ruth, Gisbert, Javier P., Taxonera, Carlos, Mañosa, Miriam, Aguas Peris, Mariam, Navarrete-Muñoz, Eva María, Sanahuja, Ana, Guardiola, Jordi, Mesonero, Francisco, Rivero Tirado, Montserrat, Barrio, Jesús, Vera Mendoza, Isabel, de Castro Parga, Luisa, García-Planella, Esther, Calvet, Xavier, Martín Arranz, María Dolores, García, Santiago, Sicilia, Beatriz, Carpio, Daniel, Domenech, Eugeni, Gomollón, Fernando, Márquez-Mosquera, Lucía, Madero, Lucia, Esteve, María, Monfort, David, Varela, Pilare, Vega, Pablo, Martínez, Guillermo Alcaín, Rodriguez-Lago, Iago, García-Bosh, Orlando, Pérez Calle, Jose Lázaro, Merino, Olga, Sierra Ausin, Mónica, Tardillo, Carlos, Lorente Poyatos, Rufo, Fernandez-Salazar, Luis Ignacio, García Sepulcre, Mariana Fe, Bermejo, Fernando, Arce, Nuria Maroto, Bujanda, Luis, Riera, Joan, Ber, Yolanda, Ponferrada Díaz, Ángel, BasCutrina, Francesc, Martinez Montiel, Pilar, Ramos, Laura, Llaó, Jordina, Barreiro- de Acosta, Manuel, Rodriguez Gutierrez, Cristina, Muñoz, Fernando, Sese, Eva, Blat, Rosa, Huguet, Jose M., Marín-Jiménez, Ignacio, Martínez-Flores, Carlos, Van Domselaar, Manuel, Lucendo, Alfredo J., Ginard, Daniel, Menacho, Margarita, Marcos, Noemí Manceñido, Almela, Pedro, de la Piscina, Patricia Ramirez, Argüelles-Arias, Federico, Vilafranca, Carmen Muñoz, Peña, Elena, Alvarez, Pau Gilabert, Santos Fernández, Javier, Coronel, Ana Fuentes, Hernández Villalba, Luis, Andres, Pilar Robledo, Martínez Perez, Teresa, Legido Gil, Jesús, Fernandez, Hipólito, Castillo Regalado, Edgar, Buendía, Lidia, Trapero Martinez, Ana María, Leal, Carles, Miyashiro, Eduardo Iyo, García Herola, Antonio, Frago, Santiago, Novella Duran, María Teresa, Navas López, Victor Manuel, de Prado, Isabel Nicolás, Bebia, Paloma, Botella, Belén, Muñoz, Rosa Ana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2024
• Subjects: Clinical Course; Crohn’s Disease; Inflammatory Bowel Disease; Patient Sex; Phenotype; Ulcerative Colitis; Crohn’s Disease; ENEIDA; CD; Phenotype; Ulcerative Colitis; Clinical Course; EIM; IBD; Inflammatory Bowel Disease; IQR; Patient Sex; UC
• ISSN: 1542-3565; 1542-7714; 1542-7714
• DOI: 10.1016/j.cgh.2024.05.013

The impact of patient sex on the presentation of inflammatory bowel disease (IBD) has been poorly evaluated. Our aims were to assess potential disparities in IBD phenotype and progression between sexes.
We 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.
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, 1.45; 95% CI, 1.31–1.62), later disease onset (age, >40 y) (relative risk ratio, 1.55; 95% CI, 1.38–1.73), exclusive colonic involvement (odds ratio, 1.24; 95% CI, 1.14–1.34), inflammatory behavior (odds ratio, 1.14; 95% CI, 1.07–1.21), and extraintestinal manifestations (odds ratio, 1.48; 95% CI, 1.38–1.59). However, female sex was a protective factor for upper gastrointestinal involvement (odds ratio, 0.84; 95% CI, 0.79–0.90), penetrating behavior (odds ratio, 0.76; 95% CI, 0.70–0.82), perianal disease (odds ratio, 0.77; 95% CI, 0.71–0.82), and complications (odds ratio, 0.73; 95% CI, 0.66–0.80). In ulcerative colitis, female sex was an independent risk factor for extraintestinal manifestations (odds ratio, 1.48; 95% CI, 1.26–1.61). However, female sex was an independent protective factor for disease onset from age 40 onward (relative risk ratio, 0.76; 95% CI, 0.66–0.87), left-sided colonic involvement (relative risk ratio, 0.72; 95% CI, 0.67–0.78), extensive colonic involvement (relative risk ratio, 0.59; 95% CI, 0.55–0.64), and abdominal surgery (odds ratio, 0.78; 95% CI, 0.69–0.88).
There is sexual dimorphism in IBD. The patient's sex should be taken into account in the clinical management of the disease.
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