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Risk of Functional Gastrointestinal Disorders in U.S. Military Following Self-Reported Diarrhea and Vomiting During Deployment

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Abstract

Introduction

Military personnel are frequently deployed to regions of the world with high travelers’ diarrhea (TD) rates. Pathogens associated with TD have been linked to several post-infectious sequelae, including functional gastrointestinal disorders (FGD), such as irritable bowel syndrome (IBS) and functional dyspepsia. Furthermore, stress associated with deployment may potentiate the increased FGD risk.

Aim

We sought to assess whether self-reported diarrhea, vomiting, and stressors during deployment were associated with increased FGD risk.

Methods

Using active duty military medical encounter data from the Defense Medical Surveillance System (DMSS), we conducted a matched case–control study to assess the odds of FGD (IBS, functional constipation, functional diarrhea, dyspepsia) following self-reported diarrhea or vomiting during deployment. Only first-time deployers with detailed self-reporting of deployment-related exposures from 2008 and 2009 were included. Univariate and multivariate analyses were performed.

Results

A total of 129 cases of FGD were identified, with the following distribution: constipation (n = 67), dyspepsia (n = 15), IBS (n = 22), and overlapping disorders (n = 25). Diarrhea and/or vomiting during deployment were significantly associated with the development of FGD. Other demographic factors were also associated with variable risk. We found no consistent effect of war-related stressors or non-combat-related correlates of stress.

Conclusions

Deployment-related TD is common in deployed military personnel and is associated with an increased risk of several FGD. When considering effective countermeasures and mitigation strategies, both the acute effects and chronic sequelae of enteric infections should be considered. Increased emphasis on existing and novel primary prevention strategies are needed, as well as outcome studies among those developing these conditions.

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References

  1. Hannu T, Mattila L, Siitonen A, Leirisalo-Repo M. Reactive arthritis attributable to Shigella infection: a clinical and epidemiological nationwide study. Ann Rheum Dis. 2005;64:594–598.

    Article  PubMed  CAS  Google Scholar 

  2. Kuwabara S. Guillain–Barré syndrome: epidemiology, pathophysiology and management. Drugs. 2004;64:597–610.

    Article  PubMed  Google Scholar 

  3. Porter CK, Tribble DR, Aliaga PA, Halvorson HA, Riddle MS. Infectious gastroenteritis and risk of developing inflammatory bowel disease. Gastroenterology. 2008;135:781–786.

    Article  PubMed  Google Scholar 

  4. Porter CK, Gormley R, Tribble DR, Cash BD, Riddle MS. The incidence and gastrointestinal infectious risk of functional gastrointestinal disorders in a healthy US adult population. Am J Gastroenterol. 2011;106:130–138.

    Article  PubMed  Google Scholar 

  5. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers’ diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009;80:609–614.

    PubMed  Google Scholar 

  6. Wilson ME. Diarrhea in nontravelers: risk and etiology. Clin Infect Dis. 2005;41:S541–S546.

    Article  PubMed  Google Scholar 

  7. Gascón J. Epidemiology, etiology and pathophysiology of traveler’s diarrhea. Digestion. 2006;73:102–108.

    Article  PubMed  Google Scholar 

  8. Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. New Engl J Med. 2004;350:38–47.

    Article  PubMed  CAS  Google Scholar 

  9. DuPont AW, DuPont HL. Travelers’ diarrhea: modern concepts and new developments. Curr Treat Options Gastroenterol. 2006;9:13–21.

    Article  PubMed  Google Scholar 

  10. DuPont HL, Galler G, Garcia-Torres F, Dupont AW, Greisinger A, Jiang ZD. Travel and travelers’ diarrhea in patients with irritable bowel syndrome. Am J Trop Med Hyg. 2010;82:301–305.

    Article  PubMed  Google Scholar 

  11. Riddle MS, Sanders JW, Putnam SD, Tribble DR. Incidence, etiology, and impact of diarrhea among long-term travelers (US military and similar populations): a systematic review. Am J Trop Med Hyg. 2006;74:891–900.

    PubMed  Google Scholar 

  12. Mearin F, Pérez-Oliveras M, Perelló A, Vinyet J, Ibañez A, Coderch J, Perona M. Dyspepsia and irritable bowel syndrome after a Salmonella gastroenteritis outbreak: one-year follow-up cohort study. Gastroenterology. 2005;129:98–104.

    Article  PubMed  Google Scholar 

  13. Talley NJ. A unifying hypothesis for the functional gastrointestinal disorders: really multiple diseases or one irritable gut? Rev Gastroenterol Disord. 2006;6:72–78.

    PubMed  Google Scholar 

  14. Sostek MB, Jackson S, Linevsky JK, Schimmel EM, Fincke BG. High prevalence of chronic gastrointestinal symptoms in a National Guard Unit of Persian Gulf veterans. Am J Gastroenterol. 1996;91:2494–2497.

    PubMed  CAS  Google Scholar 

  15. Koch TR, Emory TS. Evaluation of chronic gastrointestinal symptoms following Persian Gulf War exposure. Mil Med. 2005;170:696–700.

    PubMed  Google Scholar 

  16. Hyams KC, Bourgeois AL, Merrell BR, Rozmajzl P, Escamilla J, Thornton SA, Wasserman GM, Burke A, Echeverria P, Green KY, Kapikian AZ, Woody JN. Diarrheal disease during Operation Desert Shield. N Engl J Med. 1991;325:1423–1428.

    Article  PubMed  CAS  Google Scholar 

  17. Gwee KA, Leong YL, Graham C, McKendrick MW, Collins SM, Walters SJ, Underwood JE, Read NW. The role of psychological and biological factors in postinfective gut dysfunction. Gut. 1999;44:400–406.

    Article  PubMed  CAS  Google Scholar 

  18. Rubertone MV, Brundage JF. The Defense Medical Surveillance System and the Department of Defense serum repository: glimpses of the future of public health surveillance. Am J Public Health. 2002;92:1900–1904.

    Article  PubMed  Google Scholar 

  19. Halvorson HA, Schlett CD, Riddle MS. Postinfectious irritable bowel syndrome—a meta-analysis. Am J Gastroenterol. 2006;101:1894–1899; quiz 1942.

    Article  PubMed  Google Scholar 

  20. Thabane M, Kottachchi DT, Marshall JK. Systematic review and meta-analysis: the incidence and prognosis of post-infectious irritable bowel syndrome. Aliment Pharmacol Ther. 2007;26:535–544.

    Article  PubMed  CAS  Google Scholar 

  21. Tuteja AK, Talley NJ, Gelman SS, Alder SC, Thompson C, Tolman K, Hale DC. Development of functional diarrhea, constipation, irritable bowel syndrome, and dyspepsia during and after traveling outside the USA. Dig Dis Sci. 2008;53:271–276.

    Article  PubMed  Google Scholar 

  22. Coker WJ. A review of Gulf War illness. J R Nav Med Serv. 1996;82:141–146.

    PubMed  CAS  Google Scholar 

  23. Coker WJ, Bhatt BM, Blatchley NF, Graham JT. Clinical findings for the first 1000 Gulf war veterans in the Ministry of Defence’s medical assessment programme. BMJ. 1999;318:290–294.

    Article  PubMed  CAS  Google Scholar 

  24. Unwin C, Blatchley N, Coker W, Ferry S, Hotopf M, Hull L, Ismail K, Palmer I, David A, Wessely S. Health of UK servicemen who served in Persian Gulf War. Lancet. 1999;353:169–178.

    Article  PubMed  CAS  Google Scholar 

  25. Ishøy T, Suadicani P, Guldager B, Appleyard M, Gyntelberg F. Risk factors for gastrointestinal symptoms. The Danish Gulf War Study. Dan Med Bull. 1999;46:420–423.

    PubMed  Google Scholar 

  26. Marshall JK, Thabane M, Borgaonkar MR, James C. Postinfectious irritable bowel syndrome after a food-borne outbreak of acute gastroenteritis attributed to a viral pathogen. Clin Gastroenterol Hepatol. 2007;5:457–460.

    Article  PubMed  Google Scholar 

  27. Pimentel M, Mayer AG, Park S, Chow EJ, Hasan A, Kong Y. Methane production during lactulose breath test is associated with gastrointestinal disease presentation. Dig Dis Sci. 2003;48:86–92.

    Article  PubMed  Google Scholar 

  28. Marshall JK, Thabane M, Garg AX, Clark WF, Moayyedi P, Collins SM; Walkerton Health Study Investigators. Eight year prognosis of postinfectious irritable bowel syndrome following waterborne bacterial dysentery. Gut. 2010;59:605–611.

    Article  PubMed  Google Scholar 

  29. Videlock EJ, Adeyemo M, Licudine A, Hirano M, Ohning G, Mayer M, Mayer EA, Chang L. Childhood trauma is associated with hypothalamic–pituitary–adrenal axis responsiveness in irritable bowel syndrome. Gastroenterology. 2009;137:1954–1962.

    Article  PubMed  Google Scholar 

  30. Klooker TK, Braak B, Painter RC, de Rooij SR, van Elburg RM, van den Wijngaard RM, Roseboom TJ, Boeckxstaens GE. Exposure to severe wartime conditions in early life is associated with an increased risk of irritable bowel syndrome: a population-based cohort study. Am J Gastroenterol. 2009;104:2250–2256.

    Article  PubMed  Google Scholar 

  31. Tjong YW, Ip SP, Lao L, Wu J, Fong HH, Sung JJ, Berman B, Che CT. Neonatal maternal separation elevates thalamic corticotrophin releasing factor type 1 receptor expression response to colonic distension in rat. Neuro Endocrinol Lett. 2010;31:215–220.

    PubMed  CAS  Google Scholar 

  32. O’Mahony SM, Hyland NP, Dinan TG, Cryan JF. Maternal separation as a model of brain–gut axis dysfunction. Psychopharmacology. 2011;214:71–88.

    Article  PubMed  Google Scholar 

  33. O’Mahony SM, Marchesi JR, Scully P, Codling C, Ceolho AM, Quigley EM, Cryan JF, Dinan TG. Early life stress alters behavior, immunity, and microbiota in rats: implications for irritable bowel syndrome and psychiatric illnesses. Biol Psychiatry. 2009;65:263–267.

    Article  PubMed  Google Scholar 

  34. Bennett EJ, Tennant CC, Piesse C, Badcock CA, Kellow JE. Level of chronic life stress predicts clinical outcome in irritable bowel syndrome. Gut. 1998;43:256–261.

    Article  PubMed  CAS  Google Scholar 

  35. Statement of Linda J. Bilmes. House Committee on Veterans’ Affairs Full Committee. http://veterans.house.gov/Media/file/111/9-30-10/111-103transcript9-30-10.htm#bilmes.

  36. Gulf War and Health: Volume 8: update of health effects of serving in the Gulf War. In: War CoGWaHHEoSitG, ed. Board on the Health of Select Populations; Institute of Medicine; 2009.

  37. United States Department of Veterans Affairs. Office of Public Health and Environmental Hazards; Gulf War Veterans’ Illnesses: Infectious Diseases. 2010; Available from: http://www.publichealth.va.gov/exposures/gulfwar/infectious_diseases.asp.

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Authors and Affiliations

  1. Enteric Diseases Department, Infectious Disease Directorate, Naval Medical Research Center, 503 Robert Grant Avenue, Silver Spring, MD, 20910-7500, USA

    Chad K. Porter & Mark S. Riddle

  2. The George Washington University, Washington, DC, USA

    Kayleen Gloor

  3. National Naval Medical Center, Bethesda, MD, USA

    Brooks D. Cash

Authors
  1. Chad K. Porter
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  2. Kayleen Gloor
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  3. Brooks D. Cash
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  4. Mark S. Riddle
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Correspondence to Mark S. Riddle.

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Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

Copyright statement: The authors are employees of the U.S. Government and military service members. This work was prepared as part of official duties. Title 17 U.S.C. §105 provides that ‘Copyright protection under this title is not available for any work of the United States Government.’ Title 17 U.S.C. §101 defines a U.S. Government work as a work prepared by a military service member or employee of the U.S. Government as part of that person’s official duties.

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Porter, C.K., Gloor, K., Cash, B.D. et al. Risk of Functional Gastrointestinal Disorders in U.S. Military Following Self-Reported Diarrhea and Vomiting During Deployment. Dig Dis Sci 56, 3262–3269 (2011). https://doi.org/10.1007/s10620-011-1762-3

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  • DOI: https://doi.org/10.1007/s10620-011-1762-3

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