RESUMO
BACKGROUND AND AIMS: The impact of patient sex on the presentation of inflammatory bowel disease (IBD) has been poorly evaluated. Our aims were to assess potential disparities in IBD phenotype and progression between sexes. METHODS: Observational multicentre study that included patients with Crohn's disease (CD) or ulcerative colitis (UC) from the Spanish ENEIDA registry. Data extraction was conducted in July 2021. RESULTS: 51,595 patients with IBD were included, 52% were males and 25,947 had CD. The median follow-up after diagnosis was 9 years in males and 10 in females. In CD, female sex was an independent risk factor for medium disease onset (17-40 years) (RRR 1.45, 95% CI 1.31-1.62), later disease onset (>40 years) (RRR 1.55, 95% CI: 1.38-1.73), exclusive colonic involvement (OR 1.24, 95%CI 1.14-1.34), inflammatory behaviour (OR 1.14, 95%CI 1.07-1.21) and extraintestinal manifestations (OR 1.48, 95%CI 1.38-1.59). However, female sex was a protective factor for upper gastrointestinal involvement (OR 0.84, 95%CI 0.79-0.90), penetrating behaviour (OR 0.76, 95%CI 0.70-0.82), perianal disease (OR 0.77, 95CI% 0.71-0.82) and complications (OR 0.73, 95%CI 0.66-0.80). In UC, female sex was an independent risk factor for extraintestinal manifestations (OR 1.48, 95%CI 1.26-1.61). However, female sex was an independent protective factor for disease onset from age 40 onward (RRR 0.76, IC 95%: 0.66-0.87), left sided colonic involvement (RRR 0.72, 95% CI 0.67-0.78), extensive colonic involvement (RRR 0.59, 95%CI 0.55-0.64) and abdominal surgery (OR 0.78, 95%CI 0.69-0.88). CONCLUSIONS: There is sexual dimorphism in IBD. The patient's sex should be taken into account in the clinical management of the disease.