Sex differences show women do worse with Crohn’s disease

Women with Crohn’s disease are struggling with more complications and more hospitalisations than men, new research has found.

According to chief investigator Professor Rupert Leong, young women are also facing some of the toughest decisions about managing life with the chronic illness – including whether or not to have children.

Professor Leong, a gastroenterologist and head of endoscopy at Concord Hospital, said the study followed more than 1,400 patients with inflammatory bowel disease (IBD) for an average of nine years.

IBD, including Crohn’s disease and ulcerative colitis, affects about 75,000 Australians.

Presented at Australian Gastroenterology Week, the study found women with Crohn’s disease had significantly worse results than men.

Complications from the disease, including strictures that can lead to bowel obstruction, and fistulas or abscesses, developed in 27.4% of women compared to 16.6% of men.

“Women seem to get a worse disease but we don’t know whether this is due to biological or behavioural factors,” Professor Leong said.

“We are aware that young women considering pregnancy will sometimes stop their medications because of concern about possible harm to their baby. What they really need to do is to stay on their IBD medications to keep the disease at bay.”

“Most IBD medications aren’t harmful to the foetus and with close monitoring, we are seeing really good pregnancy outcomes,” he said.

He added that some women were choosing not to have children because of their disease.

The study found women were also more likely to have complications of Crohn’s disease beyond the gut, such as inflammation in the joints and eyes (34.2% in women v 25.6% in men).

IBD related hospitalisations were also 25% more frequent in women than men.

“Hormonal differences may also account for the accelerated disease progression seen in women,” Professor Leong said. “There has been some weak association with the use of oral contraceptive pill and onset of IBD.”

He said the findings were consistent with overseas research that found men were more likely to achieve remission of their disease than women.

Professor Leong said the gender effect may indicate a need for early discussion regarding the safety of medication during conception and pregnancy as well as for more effective treatments for women.

Women and men in the study were receiving equivalent medical and surgical treatments.

(Source: Gastroenterological Society of Australia)