Crohn's disease manifests differently in boys and girls

NEW YORK (Reuters Health) -- In pediatric patients with Crohn's disease, disease severity tends to be worse in females, whereas males are more prone to growth retardation, results of a large database analysis suggest.

"Gender differences in the course of Crohn's disease are unclear," Dr. Melvin B. Heyman at the University of California, San Francisco, and colleagues state in the December issue of Pediatrics. "Identifying differences in the expression of disease by gender can enhance our understanding of the etiology, underlying genetic and pathophysiologic mechanisms, and the natural history of Crohn's disease."

Using the Pediatric IBD Consortium Registry, Dr. Heyman's team compared 566 boys and 423 girls diagnosed with Crohn's disease before age 17. Statistically significant differences by gender were noted during a mean follow-up of 3.6 years.

Girls had a higher prevalence of mouth sores and hypoalbuminemia at diagnosis, and they were at greater risk for erythema nodosum/pyoderma gangrenosum and for a first intestinal resection. Cyclosporine was used more often among girls, most likely reflecting "disease severity that is refractory to first-line medical management," the authors suggest.

Boys were more likely than girls to develop growth failure (cumulative incidence at 10 years of age, 12.6% versus 4.0%).

Age at diagnosis and disease location were similar in boys and girls. Also, there were no apparent differences in risk of developing fissures, fistulas or abscesses; renal calculi; compression fractures or osteopenia/osteoporosis; or sclerosing cholangitis.

Dr. Heyman and his team call for prospective longitudinal studies that incorporate disease activity indices, Tanner staging, bone age, and serial height and weight data.