Gastroenterology

Gastroenterology

Volume 130, Issue 5, April 2006, Pages 1435-1446
Gastroenterology

Introduction
Gender, Age, Society, Culture, and the Patient’s Perspective in the Functional Gastrointestinal Disorders

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Patients with functional gastrointestinal disorders (FGID) often experience emotional distress, a perceived lack of validation, and an unsatisfactory experience with health care providers. A health care provider can provide the patient with a framework in which to understand and legitimize their symptoms, remove self-doubt or blame, and identify factors that contribute to symptoms that the patient can influence or control. This framework can be strengthened with the consideration of various important factors that impact FGID but are often overlooked. These include gender, age, society, culture, and the patient’s perspective. There is evidence for sex- and gender-related differences in FGID, particularly irritable bowel syndrome (IBS). Whereas the majority of FGID, including IBS, bloating, constipation, chronic functional abdominal pain, and pelvic floor dysfunction, are more prevalent in women than men, functional esophageal and gastroduodenal disorders do not appear to vary by gender. Limited studies suggest that sex differences in visceral perception, cardioautonomic responses, gastrointestinal motility, and brain activation patterns to visceral stimuli exist in IBS. Gender differences in social factors, psychological symptoms, and response to psychological treatments have not been adequately studied. However, there appears to be a greater clinical response to serotonergic agents developed for IBS in women compared to men. The impact of social and cultural factors on the meaning, expression, and course of FGID are important. The prevalence of IBS appears to be lower in non-Western than Western countries. Although further studies are needed, the existing literature suggests that they are important to consider from both research and clinical perspectives.

Section snippets

The Patient’s Perspective

The illness experience of persons with FGID, such as IBS, is similar to that of those who live with other chronic conditions of uncertain etiology and ambiguous diagnostic criteria. Chronic illnesses are characterized by long-term courses, unpredictable symptom episodes, and disabling effects that are often accompanied by minimally effective treatments, social stigma, and isolation.1 Symptoms place demands on families as well as patients, and impair functioning while placing perpetual demands

Sex, Gender, and Gender Role

Sex is generally used to refer to a person’s biological femaleness or maleness. Gender is generally used to refer to the nonbiological aspects of being female or male, in other words, the social or cultural expectations associated with femininity or masculinity.10 However, we know that most differences between males and females are a function of the interaction between biology and environment. In this review, gender is used as a more inclusive term. Sex is used for the classification of

Age

In regard to the functional esophageal disorders, the prevalence of most of these disorders decreases with age (Table 1). Specifically, globus, rumination syndrome, and self-reported functional chest pain are all more common in younger people.12, 88, 89 The prevalence of heartburn overall is similar among people ages 25–74.88 The prevalence of dysphagia in one study increased with age, most notably in participants in the 65- to 74-year-old category.88

Some studies have suggested that the

Society

In spite of our growing understanding of so-called functional somatic disorders in general, and disorders associated with FGID, the stigma associated with a functional disorder may lead patients to believe that their problems are treated as “not real” and due to a psychological or moral defect or weakness.101 It is often contrasted with organic disease and thought to be less legitimate or real.

Several societal myths associated with FGID, in particular IBS, persist today: symptoms are trivial or

Culture

Culture is the values, beliefs, norms, and practices of a particular group that are learned and shared and that guide thinking, decisions, and actions in a patterned way.106 Culture-related factors can affect the type of health care and health outcomes.

Methodologic Issues in FGID

Because of methodologic issues, which have limited interpretation of studies, there remain many unanswered questions concerning gender, age, society, culture, and the patient’s perspective in FGID. Because of the female predominance and greater likelihood of women to participate in research studies, there are insufficient numbers of male participants to make meaningful interpretations and adequately assess gender differences in psychological, physiological, and treatment studies. Another major

Conclusion and Future Directions

This review examined the literature regarding the relationship between gender, age, society, culture, and FGID. Important factors pertaining to FGID that were emphasized include (1) the importance of the patient’s experience and perspective; (2) the influence of society, culture, gender, and age on all aspects of the individual’s experience; (3) the influential role of an individual’s sex on the biologic and physiologic processes of brain–gut interactions; and (4) the potential of the health

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