Gender Differences of Clinical Parameters for Years before RE Onset in Reflux Esophagitis (RE) Patients Compared with Non-RE Subjects

Background: Gender differences in reflux esophagitis (RE) were generally recognized in several aspects, in which prevalence of RE was higher in male than in female.Although we previously reported that clinical parameters associated with lifestyle diseases rapidly worsened for years before RE onset in patients, little is known whether predictive factors of future RE are common by gender or not.Hence, we carried out subgroup analysis by gender to investigate and compare the predictive factors using long-term health checkup records.Methods: We used health checkup records between April 2004 and March 2014 at nine institutions in Japan.Subjects who were newly diagnosed as RE between April 2009 and March 2014 were included in the analysis as case subjects.For each case subject, two subjects who had no RE diagnosis between April 2004 and March 2014 and were matched for age, sex, and participating institutions with the corresponding case were included as control subjects.We divided these subjects into subgroups of male and female, and the time courses of clinical parameters in case group were compared with those in control group by the restricted maximum likelihood method for repeated measures or multivariate logistic analysis, appropriately.Results: Initial data were obtained from 230,056 individuals, and 2,066 case subjects (1,558 males and 508 females) and 4,132 control subjects (3,116 males and 1,016 females) were included in the analysis.Means and standard deviations of age were 53.9±9.6 (male case), 54.1±8.4 (female case), 54.0±9.7 (male control), and 53.9±8.3 (female control).Regarding the male group, the time courses of body mass index (BMI) (p<0.001),abdominal circumference (p<0.001),fasting blood sugar (p=0.009),serum triglyceride (p=0.022),high-density lipoprotein cholesterol (p=0.040),glutamate oxaloacetate transaminase (p=0.035),glutamic pyruvic transaminase (p=0.003),γ-glutamyl transpeptidase (p<0.001), and percentages with acid reflux symptoms (p=0.003) in the case group showed more rapid worsening than in the control group.On the other hand, regarding the female group, no significant differences in the time-courses of parameters were observed between case and control group.Conclusions: The male RE group displayed a more rapid worsening of the clinical parameters associated with lifestyle diseases compared with the male non-RE group similarly to the analysis for all subjects, whereas these results were not shown in the female RE group.These results suggest that the risk factors of RE differ between male and female, and different approaches according to gender should be necessary to prevent RE development.