Patient Experience, Gender, Age, Race, and Social Determinants of Health.

Abstract

Women are disproportionately affected by disorders of gut-brain interaction (DGBI), including esophageal, gastroduodenal, bowel, and anorectal conditions, and frequently experience overlapping pain syndromes. This review synthesizes clinical and preclinical evidence on sex- and gender-related differences in DGBI, highlighting alterations in central pain processing, autonomic regulation, stress, microbiota composition, epithelial permeability, motility, genetic and epigenetic factors, and immune responses that may underlie observed disparities. Emerging data indicate that gonadal hormones, interacting with environmental stressors across the lifespan, modulate symptom severity and disease course. Social determinants of health, inadequate patient-provider communication, and disorder-associated stigma further exacerbate inequities in diagnosis and care. Research remains limited by lack of standardized definitions of sex and gender, under-representation of men and gender minorities, and insufficient consideration of hormonal changes and exogenous hormone exposure. Addressing these gaps is essential to advance our understanding of DGBI and guide gender-informed diagnostic and therapeutic strategies for DGBI management.