The Esophagus: Do Sex and Gender Matter?

Abstract

The esophagus has a single rudimentary function of active transport of solids and liquids from the pharynx to the stomach and, rarely, venting of the stomach with retrograde passage of gastric contents into the pharynx. It is void of any digestive, absorptive, metabolic, or endocrine functions. Despite this simplicity of function, sex (biological and physiological characteristics, ie, male versus female) and gender (roles, behaviors, activities, and attributes that a given society considers appropriate, ie, man versus woman) differences exist in both normal esophageal function and esophageal disease. Some components of esophageal function are sex-dependent, and these differences must be considered in the interpretation of functional testing. In esophageal disease, particularly gastroesophageal reflux disease, Barrett esophagus, esophageal cancer, acquired immune deficiency syndrome, and scleroderma, there are sex and gender differences in the pathophysiology and response to treatment. Although discussions of treatment and outcomes might differ between the sexes and genders, there are no important data to support different care on the basis of sex or gender.