The influence of gender on the aetiology of gastro-oesophageal reflux, Barrett’s oesophagus and oesophageal adenocarcinoma

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http://eprints.org/relation/isVersionOf http://etheses.bham.ac.uk/id/document/16567 http://eprints.org/relation/isVolatileVersionOf http://etheses.bham.ac.uk/id/document/16567 http://eprints.org/relation/isIndexCodesVersionOf http://etheses.bham.ac.uk/id/document/16567 archive 4031 disk0/00/00/30/08 2011-11-24 15:09:11 2019-01-23 09:55:19 2011-11-24 15:09:11 thesis show 0 Menon Shyam Sundar Trudgill Nigel University of Birmingham The influence of gender on the aetiology of gastro-oesophageal reflux, Barrett’s oesophagus and oesophageal adenocarcinoma unpub QM QP RC 10col_mede Symptoms of gastro-oesophageal reflux disease are equally common in both sexes and at all ages. However, complications of gastro-oesophageal reflux disease such as reflux oesophagitis, Barrett's oesophagus and oesophageal adenocarcinoma, although more common in men, increase sharply in older women, suggestive of a protective effect of female sex hormones in menstruating women. Oestrogen has anti-inflammatory properties, improves healing in oral and skin wounds and may therefore reduce the severity of reflux-induced oesophageal mucosal injury, consequently protecting women from developing severe reflux oesophagitis. Long-term oestrogen treatment with hormone replacement therapy seems to be additionally associated with a reduction in the risk of oesophageal cancer. Moreover, there are gender-specific genotypic differences in the response of oesophageal mucosa to chronic acid reflux suggestive of multiple factors that may play a role in explaining the male predominance of oesophageal adenocarcinoma. Finally, oestrogen has no association with the severity of acid reflux once adjustment is made for the influence of increasing body mass index in women undergoing oesophageal pH monitoring. The gender difference in the prevalence of gastro-oesophageal reflux disease and its complications may thus be related to the effect of female sex hormones, particularly oestrogen and its 'protective' effect in pre-menopausal women. 2011-12 2011-09 graduation eng author unchecked This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. public 207 University of Birmingham Institute of Cancer Studies h_md na 2011-12 graduation