Gender differences in symptoms suggestive of diabetic gastroparesis in the West Bank: clinical insights from a cross-sectional study.

Introduction: Diabetic gastroparesis (DGP) is a common complication among DM patients, with a prevalence between 5 and 15%, manifest as upper gastrointestinal symptoms, including nausea, postprandial fullness, vomiting, early satiety, and bloating. The pathogenesis is not completely understood, and has been linked with multiple risk factors, one of which is the female gender. Although females are 4 times more likely to develop DGP, there is still not enough evidence on the exact mechanisms underlying sex-related differences. In this research, we aim to conduct a cross-sectional survey to provide large-scale, region-specific data on gender differences in both the prevalence and severity of gastroparesis symptoms, as well as to identify independent associated factors of symptoms burden among patients with type 2 DM. Methods: A cross-sectional study was conducted, a total of 3,248 were included in our study, and assessed gastroparesis symptoms using a validated Arabic version of the Gastroparesis Cardinal Symptom Index (GCSI). Results: Our study showed that females had a higher prevalence of obesity, poorer glycemic control, and DGP and were more likely to have a severe picture of DGP related symptoms (GCSI score of ≥3.5). Female patients reported a significantly higher prevalence of all gastroparesis symptoms compared to male patients, and reported significantly higher mean severity scores for all symptoms. Logistic regression also showed that female gender is the only independent associated factor with the severe form of gastroparesis symptoms compared to male (OR: 2.38) Discussion: DGP prevalence is 4 times higher in females and reported higher severity scores of DGP symptoms, especially nausea, early satiety, fullness, bloating, and loss of appetite. Multiple theories have tried to explain, including slower gastric emptying in females due to estrogen hormone and neuronal nitric oxide synthase, which affects GI smooth muscle motility and some physiological differences. Conclusion: Female gender is an associated factor for developing DGP and the only independent factor associated with DGP severity. However, the underlying mechanism is not fully understood. This raises the need for targeted research, as a better understanding of DGP is a necessity to implement gender-based management plans.