Gupta N et al. (2007) Gender differences in presentation and course of disease in pediatric patients with Crohn disease. Pediatrics 120: e1418–e1425

Identification of differences in Crohn's disease between male and female patients could provide useful insights into the etiology, pathophysiology and genetics of the disease. Gupta and colleagues, therefore, conducted a multicenter, retrospective study in the US to examine sex-related differences in the presentation and course of Crohn's disease in 989 pediatric patients (mean age at diagnosis 11.5 years; 566 boys and 423 girls) enrolled in the Pediatric IBD Consortium Registry.

The median follow-up period after initial diagnosis of IBD was 2.8 years. No differences between girls and boys were observed for age at diagnosis of IBD, initial classification of disease, location of disease at diagnosis, or prevalence of granuloma on initial histology. However, girls had a higher prevalence of mouth sores at symptom onset and of hypoalbuminemia at the time of diagnosis, and a higher proportion of girls than boys had abnormal levels of antibodies against Escherichia coli outer-membrane porin. The risk of developing erythema nodosum or pyoderma gangrenosum was also increased in girls compared with boys, and girls were more likely than boys to be treated with ciclosporin—a second-line therapy. By contrast, boys had an increased risk of developing growth failure compared with girls.

These findings, in combination with those of previous reports, suggest that girls with Crohn's disease have a more-severe disease course but a lower risk of developing growth failure than boys; prospective longitudinal studies are warranted to confirm and further explore these differences.