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January 2011



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Jennifer Burke Labriola, Burke PR
Anne-Louise Oliphant, American College of Gastroenterology

In two new studies, presented at the American College of Gastroenterology’s (ACG) 74th Annual Scientific meeting in San Diego, researchers explored the connection between high stress, high exposure occupations and long-term gastrointestinal disorders.

The studies, performed by the United States Navy and the State University of New York (SUNY), Stonybrook examine the long term effects of infectious gastroenteritis (IGE) among active duty military and the interaction between gastroesophageal reflux (GERD) and mental health disorders among World Trade Center workers, respectively.

Dr Mark Riddle, of the United States Navy, led the study that examined functional gastrointestinal disorders within the active military population and their connection to infectious gastroenteritis. Infectious gastroenteritis can be caused by a variety of factors, including exposure to bacterial pathogens, protozoa and/or certain viruses, and active duty military personnel are at high risk during deployments.

Using electronic medical records obtained through the Defense Medical Surveillance System, Dr Riddle and his colleagues identified 31,866 cases of functional gastrointestinal disorders, including irritable bowel syndrome, functional constipation or diarrhea, and dyspepsia, in active duty personnel between 1999 and 2007. Matching each case to four corresponding non-FGD controls, the team calculated functional gastrointestinal disorders incidence rates, as well as performed an assessment of differential risk for functional gastrointestinal disorders associated with the type of infectious gastroenteritis exposure.

The researchers found a significant association between infectious gastroenteritis and all functional gastrointestinal disorders, with the highest risk of functional diarrhea and irritable bowel syndrome and moderate risk with functional constipation and dyspepsia. They also found that risk of functional gastrointestinal disorders generally increased nearer to infectious gastroenteritis exposure and that exposure to bacteria was associated with the highest risk overall. Importantly, 28.8 percent of active duty personnel studied still received functional gastrointestinal disorders related-care two years after their initial diagnosis.

In both historical and modern times, wherever and whenever military personnel have been placed into the austere environments of combat operations or humanitarian relief missions, the acute impact of infectious gastroenteritis is present,” explains Dr Riddle. “Until now, the long term consequences of infectious gastroenteritis exposure and the resultant consequences have not been documented or considered. Given the self-limited nature of infectious gastroenteritis and effective antibiotic therapy, we tend to relegate these infections to mere ‘battle-field’ nuisances. However, our view of disease burden must extend beyond the deployment time-horizon and consider the health of the sailors, soldiers, marines and airmen who return home and become veterans. Consideration of both the acute illness and chronic sequelae reinforce our need to enhance current strategies and develop novel solutions to limit and prevent exposure at the outset.

Shortly after September 11, 2001, high frequencies of gastroesophageal reflux (GERD) and mental health disorders were reported among exposed World Trade Center (WTC) responders. Dr Douglas Brand and Dr Yvette Lam were part of a team at the Long Island WTC Responder Center that examined the results of 697 WTC responders who were seen in 2005 to determine whether these conditions persisted over time and whether they were related to one another.

Among these responders, 41 percent of those examined had GERD, more than twice the 20 percent incidence rate among the general population. Furthermore, patients with GERD also had a higher prevalence of mental health disorders, including Post-Traumatic Stress Disorder and depression. In fact, patients with greater numbers of mental health disorders had progressively higher rates of GERD at their assessment: one mental health disorder 47.27 percent, two disorders 64.4 percent, 3 disorders 69.7 percent, and 4 disorders 72.2 percent.

The researchers also evaluated other environmental and lifestyle factors commonly associated with GERD, including smoking and obesity, but found no association with the increased frequency of GERD among WTC workers. However, length of exposure at the WTC site correlated with the diagnosis of both PTSD and GERD.

Eight years after 9/11 we are still realizing the after-effects on those who responded and participated in the massive clean-up efforts,” said Dr Brand. “Shortly after this highly stressful and toxic exposure, the appearance of GERD characterized by high co-morbidity with mental health disorders, but no relation to obesity or smoking, suggests that mental health disorders may play an important role in the persistence of GERD among these workers. Thus, treatment of the underlying mental health disorder may be necessary to resolve the physical manifestation of GERD.

Hopefully, these insights will help us better understand the mind-body connection and to treat other first responders following high-stress, high exposure deployments.

Riddle MS, Gormley R, Porter CK, et al. Post-Infectious Functional Gastrointestinal Disorders in the U.S. Military Presentation 1, ACG 2009 Annual Scientific Meeting, San Diego, 2009 Oct 26.

Lam Y, Brand D, Bucobo JC, et al. The Interaction of GERD and Mental Health Disorders (MHDs) Among World Trade Center (WTC) Workers. Presentation 21, ACG 2009 Annual Scientific Meeting, San Diego, 2009 Oct 27.

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