Gastrointestinal Disorders in Women
Abstract: Abstract: This doctoral thesis has sought to clarify the influence of gender in gastrointestinal (GI) disorders. Women with different hormone profiles were investigated, their colonic microbiota was characterized, and the impact of lifestyle and risk factors for GI disease were examined. In a pilot study, the relation between vaginal and rectal lactobacilli flora and hormone levels was investigated in 20 fertile and 20 postmenopausal women. No correlation was found between the overall levels of Lactobacillus species in the vagina and rectum, and no variations in sex hormone levels were found. L. plantarum was most often found in the rectal flora of both fertile and postmenopausal women, and L. crispatus was found more often in the vaginal flora of fertile women than in that of postmenopausal women. We characterized the mucosa-associated microbiota in the ascending colon in two women with collagenous colitis. After cloning and sequencing of the bacterial 16S rRNA genes, we found that the overall composition of the colonic microbiota was similar to that of a healthy woman and consists of a predominance of Firmicutes and Bacteroidetes. Interestingly, both patients had a high proportion of potentially pathogenic species of Bacteroides and clones related to Clostridium clostridioforme. Gastroparesis and esophageal dysmotility are common complications of diabetes mellitus in both symptomatic and asymptomatic patients. In a cross-sectional study, we evaluated esophageal and gastric motility, GI symptoms, secondary complications, and plasma biomarkers in consecutive patients with diabetes mellitus. We found an unexpectedly high prevalence of esophageal dysmotility, which presented as a strong association with retinopathy. Furthermore, the majority of patients suffered from GI symptoms that were not associated with objectively measured dysmotility A total of 131 female patients with microscopic colitis (MC) were examined with regard to smoking and alcohol habits compared to population-based controls. The main finding was that current smoking – independently of other lifestyle factors – was associated with an increased risk of developing persistent MC or MC with concomitant irritable bowel syndrome (IBS)-like symptoms, but current smoking was not associated with the development of solely MC without IBS symptoms. Past smoking was associated with transient MC. Taken together, some GI disorders are more common in women. No obvious hormonal explanation could be found, although the rectal lactobacilli flora was not as sensitive as the vaginal lactobacilli flora to hormonal influences. The microbiota in the colon of patients with MC is similar to healthy individuals, but with a higher proportion of Bacteroides. Men and women with diabetes mellitus have the same amount of symptoms and dysmotility when examined consecutively. Esophageal dysmotility is more common than gastroparesis in patients with diabetes mellitus, and it is strongly associated with retinopathy. Smoking is an important risk factor in the development of MC independently of other lifestyle factors.
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