Sex/Gender Differences in Pancreatic and Biliary Diseases

Knowledge about sex and gender differences in common pancreatobiliary diseases is essential for precision medicine, but these differences are somewhat distinct between Eastern and Western countries. In Western countries, the incidence of gallstones is higher in women with two to three times the rate compared to men, and cholesterol stones are predominant, whereas in Asian countries, the incidence is approximately equal between the sexes, and there is a similar proportion of cholesterol and pigment stones. An explanation for this difference is that cholesterol stones are dependent on estrogen levels and obesity, and women in Western countries have higher rates of obesity than Asian women. The reasons and timing of cholecystectomy differ between the sexes, with men receiving it for complicated gallstones at an older age, and women receiving it for biliary pain at a younger age. Men have a more severe clinical course or more comorbidities for acute cholecystitis compared to women. Women are more likely to develop sphincter of Oddi dysfunction, post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis, and anomalous union of the pancreaticobiliary duct; thus, ERCP for middle-aged women should only be done under strict indications. Men have a higher incidence of acute or chronic alcoholic pancreatitis due to their higher alcohol consumption than women, but women tend to progress to chronic pancreatitis with less alcohol use and in a shorter time than men. Women have a higher incidence of most cystic neoplasms (serous, mucinous, or solid pseudopapillary neoplasms) of the pancreas, while men have a higher incidence of intraductal papillary mucinous neoplasms. The incidence of bile duct cancer and pancreatic cancer is higher in men than in women. In most parts of the world, the incidence of gallbladder cancer is higher in women, except in South Korea, where it is similar between the sexes. Further research into sex and gender medicine in pancreatobiliary diseases should take into account racial and regional diversity.