The gut is officially recognized as the “second brain” of humans. His well-being sails in two directions, which see him as both a passive and an active agent. It has a functionality often linked to brain activity, but, in turn, it can affect the full efficiency of the brain itself and of the nervous system more generally.
“The relationship between the brain and the intestine that travels on the basis of neurotransmitters – he explains Elisabetta Buscarini, Director of the Medical Sciences Department of UOC Gastroenterology and Digestive Endoscopy ASST at the Ospedale Maggiore in Crema – it is very important for the proper functioning of the digestive system; but it is not the only factor at play. Others, such as the composition of the intestinal microbiota, the type of diet, the immune barrier of the mucosa, the permeability of the mucosa, environmental stress, can decisively affect our digestive health. In an attempt to synthesize all the factors at play in the health of the intestine, we speak of a bio-psycho-social model in which biological factors interact with the social and psychological factors of the individual “.
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Gastrointestinal health: differences between men and women
Today in Italy only 40% of citizens undergo the occult blood test in feces for the prevention of colorectal cancer, and women adhere in a higher percentage than men. But if for both sexes the connection between the brain and the intestine is a fact, there are substantial differences between the male and female digestive systems. “In gastroenterology – explains Dr. Buscarini – about 60% of patients are women, and many disorders are more common in them. Gender differences in the physiology (ie in the functioning) of the digestive system are known: many studies have highlighted differences in gender in gastrointestinal motility and transit time To be precise, the total gastrointestinal transit time in women is 38/91 hours, compared to 30/44 hours in men.
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And there are other differences related to sex – continues the expert -. For example, dyspepsia during the menstrual cycle is very common. Constipation is much more common in women: 80% of patients with this problem are women. ”
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Colon diseases: the most exposed women?
Can we therefore say that colon diseases affect women more than men? “This is true only for some diseases of the colon, typically for functional disorders – explains the expert – 12% of women suffer from irritable bowel syndrome and in total 60-70% of subjects with this disorder are women; also with regard to constipation or obstructed defecation, a more complex evacuation disorder, the woman / man ratio is 4 to 1 “.
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Why these differences? “Women are more sensitive: all things being equal, women are exposed to greater stress than men with respect to family responsibilities, social pressures and expectations. Unfortunately, mental stress favors functional bowel disorders. Women have greater worry and embarrassment. of men to use the bathroom outside the home. This factor often results in postponing the evacuation, and this contributes to constipation. Another important reason for the difference between women and men is certainly related to hormonal fluctuations. Many women notice changes in the frequency of defecation during the menstrual cycle. And some studies on the gastrointestinal effects of sex hormones have revealed that the gastrointestinal transit time was longer in the second phase of the cycle. ”
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Intestinal disorders and social life
So, especially for women, can we talk about physical discomfort, but also social in the presence of what is called IBS, or irritable bowel syndrome? “It must be remembered that, if not addressed correctly, IBS has very high costs for the individual and for society: indirect costs such as lost work days (730 hours / year per person with IBS), lower work yield and intangible costs such as the reduction of the quality of life and the alteration of family and work relationships.
We must also say that many more days are lost due to IBS-related disorders than those due to IBS itself (16 versus 2 / year). A true doctor-patient alliance is needed that addresses the entirety of the syndrome and its impact on the quality of life: the extraintestinal manifestations of IBS must also be addressed, in particular the psychological reflexes of this syndrome “.
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Monitor the health of our intestines
In what percentages do male and female patients tend to monitor their gastrointestinal health and get some positive results? “We are talking about the most important form of control of one’s digestive health: the path of colorectal cancer screening offered free of charge by the state to all Italians, men and women, from the age of 50. Screening programs invite the population to perform free fecal occult blood tests or, in the Piedmont region, sigmoidoscopy. Organized screening programs have radically changed the incidence (decreased by 20%) and mortality (decreased by 30%) for this tumor. Unfortunately however, the national average adherence to the invitation to take this test has remained around 40% over the years (and has further decreased during the Covid pandemic); however it should be emphasized that women in all age groups adhere more than men “.
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A manageable syndrome, but without definitive remedies
How can this syndrome be addressed? And can it be healed? “If it is difficult to talk about healing in the case of IBS – continues Buscarini – it is correct instead to talk about long-term management, in which it is important to consolidate the correct lifestyles and nutrition, which can often alone represent an important improvement to the IBS problem “.
But will the brain always make the lion’s share of the intestine? “Anxiety and environmental stress (work, family, school problems) are some of the possible causative factors of irritable bowel; on the other hand mood disorders, such as anxiety and depression are very frequently associated with irritable bowel: it is the same disorder with several faces, and not many different disorders that require the multiplication of visits and consultation of specialists! The patient must be understood, and must obtain a personalized, “tailored” approach, which takes into account all the ailments “.
The role of supplements
And probiotics that, as we know, help, but do not solve: is it good to take them anyway? “Their administration must be decided by the gastroenterologist specialist – emphasizes the doctor – For example, although the evidence available so far is not of indisputable quality, there is evidence that probiotics can also significantly improve irritable bowel symptoms both globally and with regard to abdominal pain and swelling, as demonstrated by a recent analysis of 43 clinical studies that evaluated different types of probiotics. They have few side effects (unfortunately mainly swelling) “.
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Some specialists argue that the intestine can be “educated”. It is true? “The best ways to correct the” lazy “bowel are non-pharmacological: increased physical exercise, fluid intake and bowel training (the so-called toilet training, also important in children, which consists in using correctly and regularly toileting immediately after meals), are generally recommended as a first-line approach. ”
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The patient’s age makes the difference
Finally, what can we say about the age factor? Does it have any influence on the good performance of our intestines? “The prevalence of chronic constipation in the Western population has a growing trend over the years, up to 20-40% in over 65s – clarifies the specialist. – Diverticulosis affects up to 80% of people between 70 and 80 years old: probably a change in the connective tissue of the colon (due to aging and the type of Western diet) contributes to the development of diverticula. We must above all remember that also colorectal cancer, the most common cancer of the digestive system and the second most frequent in men and women, has an age-related incidence: in both sexes the incidence increases progressively with age and is higher in males: up to 100 new cases / year are observed per 100,000 in the age group 50-69 and in the over-eighty-year-olds values higher than 400 cases per 100,000 / year “.
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