WebMD Medical News
Louise Chang, MD
Oct. 27, 2009 -- Stress can be hard on your gut. And that may be especially
true when the work environment is extraordinarily stressful -- such as cleaning
up after the 9/11 attacks or serving in the military, according to researchers
who have found a link between these stressful jobs and gastrointestinal
The studies were presented this week at the annual meeting of the American
College of Gastroenterology in San Diego.
Workers who helped with the cleanup at the World Trade Center after the 9/11
attacks are more likely than the general population to get GERD (gastroesopheal
reflux disease), in which contents of the stomach travel back up to the
esophagus, says Yvette Lam, MD, a gastroenterologist at Stony Brook University
Medical Center, N.Y., who presented the results of a study at the meeting.
She also found an association between GERD and mental health disorders.
With her colleagues, she evaluated 697 patients, ages 34 to 50, who helped
with the cleanup. At the first visit, conducted between October 2005 and
September 2006, 41% had GERD, compared with about 20% of the general
The researchers also found those with GERD were more likely to have mental
health disorders such as depression or anxiety. At the first visit, 21% of
those with GERD had posttraumatic stress disorder (PTSD), 21.5% had depression,
and nearly 30% had anxiety disorder.
In all, 413 patients came for the second visit conducted about two years
later, to see if the problems persisted. At visit two, the mental health
problems persisted, with 21.3% of those who had GERD at the first visit
reporting PTSD and 32.8% reporting depression.
''The GERD prevalence also rose with an increasing number of mental health
disorders," Lam says. Obesity, considered a risk factor for GERD, wasn't linked
with it in this study. But exposure to such things as dealing with human
remains was associated with both the GERD and the PTSD, she says.
Treatment of the mental health disorders may be crucial to resolving the
GERD, Lam says.
Gastrointestinal problems are also prevalent in military personnel, says
Mark Riddle, MD, DrPH, a researcher at the Naval Medical Research Center in
Silver Spring, Md. Servicemen and servicewomen, he says, "are under a lot of
stress as you can imagine during deployment."
Riddle says the fourth leading cause of visits to VA Medical Centers is
To find out more, Riddle and his colleagues evaluated data from the Defense
Medical Surveillance System, identifying nearly 32,000 cases of
gastrointestinal problems in active duty U.S. military personnel between 1999
and 2007. Among the problems were constipation, diarrhea, irritable bowel
syndrome (IBS), and indigestion after an infection of the stomach and
When Riddle looked for links between the past gastrointestinal problems and
current ones, he found an association between a history of gastroenteritis --
infection of the stomach and intestines caused by bacteria, virus, or other
organisms -- and all types of gastrointestinal problems later.
The highest risk was for diarrhea and IBS. Having a history of
gastroenteritis boosted the risk of diarrhea sixfold, and of IBS nearly
fourfold. The increased risk for constipation or indigestion was less, each
The gastrointestinal problems persist, Riddle found. Nearly 30% of the
military with problems were still getting care two years after the
The typical advice to prevent gastrointestinal infections -- such as boiling
water or peeling food that may be contaminated -- doesn't hold up in combat
situations or emergency environments such as the post 9/11 cleanup, Riddle
''We are developing vaccines to hopefully prevent [gastrointestinal
infections]," he says.
"We need to come up I think with a vaccine -- a good solution -- or
chemoprophylaxis like you take for malaria. But it would have to be something
you could safely take for a long time."
SOURCES:American College of Gastroenterology annual meeting, San Diego, Oct. 23-27,
2009.Yvette Lam, MD, gastroenterologist, Stony Brook University Medical Center,
N.Y.Mark Riddle, MD, DrPH, Naval Medical Research Center, Silver Spring, Md.
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