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Guadagnoli L, Mashimo H, Lo WK. Assessment of Post-traumatic Stress Disorder Among Objective Esophageal Motility and Reflux Phenotypes in Symptomatic Veterans. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09920-6. [PMID: 36378471 DOI: 10.1007/s10880-022-09920-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Prior research suggests post-traumatic stress disorder (PTSD) is associated with the development of esophageal symptoms. We aimed to evaluate the prevalence of PTSD in veterans with esophageal symptoms, and assess for differences in objective esophageal motility and reflux classifications. Consecutive veterans reporting esophageal symptoms (e.g., dysphagia and reflux) underwent clinical evaluation with standard reflux and motility testing. Relevant demographic, mental health, and clinical esophageal information was gathered. Patients were classified into "PTSD" and "Non-PTSD" groups based on the documentation of a clinician-confirmed diagnosis of PTSD in the medical chart. Of the 273 consecutive veterans (89% men, mean age: 62 years) that met inclusion criteria for the study, 34% had a clinician-confirmed diagnosis of PTSD. Differences existed between PTSD and non-PTSD groups on smoking, bipolar disorder, depression, ADHD, and opiate use. However, no differences existed in objectively determined motility or reflux phenotypes. While PTSD was highly prevalent among our sample of symptomatic veterans, the presence of PTSD was not associated with differences in motility classifications and reflux phenotypes. These findings are consistent with recent research in psychogastroenterology, which suggests psychological processes are important to consider across esophageal classifications.
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Elton AC, Severson EP, Ondrey FG, Opperman DA. Observations of increased gastroesophageal reflux symptomology in an anhydrous ammonia exposed population. Am J Otolaryngol 2022; 43:103604. [PMID: 35981434 DOI: 10.1016/j.amjoto.2022.103604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This case series describes a cohort of patients exposed to anhydrous ammonia vapors with clinical findings of laryngopharyngeal reflux (LPR). The study characterizes the identification of LPR as a consequence of vapor inhalation and the utility of PPI therapy in LPR secondary to inhalational ammonia exposure. METHODS This is a case series of 15 patients exposed to anhydrous ammonia from a single chemical spill who experienced LPR several months after exposure. Symptoms of LPR were assessed at their initial consultation and by phone at least 30 days after treatment with low-dose PPI or diet modification. At this visit, patients underwent complete head and neck examination and flexible direct laryngoscopy. RESULTS 15 patients were available for analysis before and after treatment. 93.3 % experienced at least three cardinal symptoms of LPR. 66 % of these patients had at least one LPR finding on flexible laryngoscopy. 73 % were treated with daily standard dose PPI, and 82 % of these patients experienced reduction of symptoms after 30 days of PPI treatment. Four of 15 patients were not taking the PPI as prescribed, and only one of these patients had resolution of LPR symptoms. CONCLUSION We conclude that there is an association between anhydrous ammonia exposure and the development of LPR symptoms. In this study, treatment with PPIs was successful in reducing symptoms for most patients, and patients who did not receive PPIs experienced symptoms for a longer time.
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Affiliation(s)
- Andrew C Elton
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
| | - Erik P Severson
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
| | - Frank G Ondrey
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA; Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
| | - David A Opperman
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota, 420 Delaware Street, MMC 396, Minneapolis, MN 55455, USA
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Liu X, Yip J, Zeig-Owens R, Weakley J, Webber MP, Schwartz TM, Prezant DJ, Weiden MD, Hall CB. The Effect of World Trade Center Exposure on the Timing of Diagnoses of Obstructive Airway Disease, Chronic Rhinosinusitis, and Gastroesophageal Reflux Disease. Front Public Health 2017; 5:2. [PMID: 28229067 PMCID: PMC5296346 DOI: 10.3389/fpubh.2017.00002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/16/2017] [Indexed: 01/21/2023] Open
Abstract
Objectives In a cohort of rescue/recovery workers exposed to the dust that resulted from the collapse of the World Trade Center (WTC), we assessed how a diagnosis of obstructive airways disease (OAD) affected the likelihood of a subsequent diagnosis of chronic rhinosinusitis (CRS) or gastroesophageal reflux disease (GERD). We also assessed whether OAD acted as a mediator of the association between exposure to the WTC rescue/recovery effort and CRS and GERD diagnoses. Methods In this prospective cohort study, we analyzed Fire Department of the City of New York physician diagnoses of OAD, CRS, and GERD that were first documented between September 11, 2001, and September 10, 2011, among 8,968 WTC-exposed firefighters. We used piecewise exponential survival models to evaluate whether OAD was a risk factor for either CRS or GERD and to assess OAD as a possible mediator. Results An OAD diagnosis significantly increased the risks for subsequent CRS [relative rate (RR), 4.24; 95% CI, 3.78–4.76] and GERD (RR, 3.21; 95% CI, 2.93–3.52) diagnoses. Further, 21% of the WTC exposure effect (high vs. low intensity) on GERD and 13% of the effect (high vs. low intensity) on CRS were mediated by a prior OAD diagnosis. Conclusion Individuals with an OAD diagnosis had elevated risks for subsequent diagnoses of CRS or GERD. Part of the effect of WTC exposure on CRS and GERD diagnoses is mediated by prior diagnoses of OAD; this mediation effect of OAD may reflect biological pathways or healthcare utilization practices.
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Affiliation(s)
- Xiaoxue Liu
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Jennifer Yip
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Rachel Zeig-Owens
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jessica Weakley
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Mayris P Webber
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Theresa M Schwartz
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - David J Prezant
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA; Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA
| | - Michael D Weiden
- Bureau of Health Services, Fire Department of the City of New York, Brooklyn, NY, USA; Department of Medicine, New York University School of Medicine, New York, NY, USA
| | - Charles B Hall
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, NY , USA
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Pellissier S, Bonaz B. The Place of Stress and Emotions in the Irritable Bowel Syndrome. VITAMINS AND HORMONES 2016; 103:327-354. [PMID: 28061975 DOI: 10.1016/bs.vh.2016.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Our emotional state can have many consequences on our somatic health and well-being. Negative emotions such as anxiety play a major role in gut functioning due to the bidirectional communications between gut and brain, namely, the brain-gut axis. The irritable bowel syndrome (IBS), characterized by an unusual visceral hypersensitivity, is the most common disorder encountered by gastroenterologists. Among the main symptoms, the presence of current or recurrent abdominal pain or discomfort associated with bloating and altered bowel habits characterizes this syndrome that could strongly alter the quality of life. This chapter will present the physiopathology of IBS and explain how stress influences gastrointestinal functions (permeability, motility, microbiota, sensitivity, secretion) and how it could be predominantly involved in IBS. This chapter will also describe the role of the autonomic nervous system and the hypothalamic-pituitary axis through vagal tone and cortisol homeostasis. An analysis is made about how emotions and feelings are involved in the disruption of homeostasis, and we will see to what extent the balance between vagal tone and cortisol may reflect dysfunctions of the brain-gut homeostasis. Finally, the interest of therapeutic treatments focused on stress reduction and vagal tone enforcement is discussed.
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Affiliation(s)
- S Pellissier
- Laboratoire Interuniversitaire de Psychologie, Personnalité, Cognition, Changement Social, Université Savoie Mont-Blanc, Chambéry, France.
| | - B Bonaz
- Clinique Universitaire d'Hépato-Gastroentérologie, CHU de Grenoble, Grenoble 09, France; Université Grenoble Alpes, Grenoble Institut des Neurosciences, Fonctions Cérébrales et Neuromodulation, INSERM, Grenoble 09, France
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North CS, Barney CJ, Pollio DE. A focus group study of the impact of trauma exposure in the 9/11 terrorist attacks. Soc Psychiatry Psychiatr Epidemiol 2015; 50:569-78. [PMID: 25319111 PMCID: PMC4363165 DOI: 10.1007/s00127-014-0970-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Much of the mental health research that has emerged from the September 11 (9/11) attacks has been focused on posttraumatic stress disorder and its symptoms. To better understand the broader experience of individuals following a disaster, focus groups were conducted with individuals from affected companies both at Ground Zero and elsewhere in New York City. METHODS Twenty-one focus groups with a total of 140 participants were conducted in the second post-9/11 year. Areas of identified concern were coded into the following themes: Disaster Experience, Emotional Responses, Workplace Issues, Coping, and Issues of Public Concern. RESULTS Discussions of focus groups included material represented in all five themes in companies both at Ground Zero and elsewhere. The emphasis and the content within these themes varied between the Ground Zero and other companies. Content suggesting symptoms of PTSD represented only a minority of the material, especially in the company groups not at Ground Zero. CONCLUSIONS This study's findings revealed an array of psychosocial concerns following the 9/11 attacks among employees of companies in New York City that extended far beyond PTSD. This study's results provide further evidence that trauma exposure is central to individuals' post-disaster experience and focus, and to individuals' adjustment and experience after disaster.
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Affiliation(s)
- Carol S. North
- VA North Texas Health Care System and Departments of Psychiatry and
Surgery/Division of Emergency Medicine at The University of Texas Southwestern Medical
Center, 6363 Forest Park Rd., Dallas, Texas 75390-8828, USA
| | - Carissa J. Barney
- Private Practice, 10300 North Central Expressway, Suite 285, Dallas, TX
75231, USA
| | - David E. Pollio
- The University of Alabama at Birmingham, Department of Social Work, College
of Arts and Sciences, Birmingham, AL, USA
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Kiefer DS. Stress-Related GERD: Strategies for an Integrative Treatment Approach. ACTA ACUST UNITED AC 2015. [DOI: 10.1089/act.2015.21201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- David S. Kiefer
- A family medicine physician at the Group Health Cooperative in Madison, Wisconsin, a clinical assistant professor in the Department of Family Medicine of the University of Wisconsin’s School of Medicine, in Madison, and an assistant clinical professor of medicine at the University of Arizona, Tucson, AZ
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Longitudinal study of the impact of psychological distress symptoms on new-onset upper gastrointestinal symptoms in World Trade Center responders. Psychosom Med 2014; 76:686-93. [PMID: 25373890 DOI: 10.1097/psy.0000000000000116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Research on the health of workers involved in the cleanup after the attack on the World Trade Center (WTC) on September 11, 2001, has documented high rates of psychological distress and upper gastrointestinal (GI) symptoms. The current article examines the concurrent and longitudinal associations of psychological distress with development of new-onset upper GI symptoms in a large sample of WTC responders. METHODS A cohort of 10,953 WTC responders monitored by the WTC Health Program participated in the study. Two occupational groups were examined, police and nontraditional responders. The cohort was free of upper GI symptoms or diagnoses at their first visit (3 years after September 11, 2001). Logistic regression was used to analyze the relationships between concurrent and preceding psychological distress symptoms of depression, generalized anxiety, panic, and probable posttraumatic stress disorder with the development of new-onset upper GI symptoms at 3-year follow-up (6 years after September 11, 2001). RESULTS Across both occupation groups, psychological distress symptoms at Visit 1 were significantly related to the development of GI symptoms by Visit 2 (odd ratios ranging from 1.9 to 5.4). The results for the concurrent relationships were similar. In addition, there were significant dose-response relationships between the number of co-occurring psychological distress symptoms at Visits 1 and 2, and increased new-onset upper GI symptoms at Visit 2. CONCLUSIONS In this large sample of WTC responders, psychological distress symptoms assessed at 3 years after 9/11 are related to reporting upper GI symptoms 6 years after 9/11.
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