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Zhang Y, Moore M, Jennings JS, Clark JD, Bayley PJ, Ashford JW, Furst AJ. The role of the brainstem in sleep disturbances and chronic pain of Gulf War and Iraq/Afghanistan veterans. Front Mol Neurosci 2024; 16:1266408. [PMID: 38260809 PMCID: PMC10800562 DOI: 10.3389/fnmol.2023.1266408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Gulf War Illness is a type of chronic multisymptom illness, that affects about 30% of veterans deployed to the 1990-91 Persian Gulf War. Veterans deployed to Iraq/Afghanistan after 2000 are reported to have a similar prevalence of chronic multisymptom illness. More than 30 years after the Persian Gulf War, Gulf War Illness still has an unexplained symptom complex, unknown etiology and lacks definitive diagnostic criteria and effective treatments. Our recent studies have found that substantially smaller brainstem volumes and lower fiber integrity are associated with increased sleep difficulty and pain intensity in 1990-91 Persian Gulf War veterans. This study was conducted to investigate whether veterans deployed to Iraq/Afghanistan present similar brainstem damage, and whether such brainstem structural differences are associated with major symptoms as in Gulf War Illness. Methods Here, we used structural magnetic resonance imaging and diffusion tensor imaging to measure the volumes of subcortices, brainstem subregions and white matter integrity of brainstem fiber tracts in 188 veterans including 98 Persian Gulf War veterans and 90 Iraq/Afghanistan veterans. Results We found that compared to healthy controls, veterans of both campaigns presented with substantially smaller volumes in brainstem subregions, accompanied by greater periaqueductal gray matter volumes. We also found that all veterans had reduced integrity in the brainstem-spinal cord tracts and the brainstem-subcortical tracts. In veterans deployed during the 1990-91 Persian Gulf War, we found that brainstem structural deficits significantly correlated with increased sleep difficulties and pain intensities, but in veterans deployed to Iraq/Afghanistan, no such effect was observed. Discussion These structural differences in the brainstem neurons and tracts may reflect autonomic dysregulation corresponding to the symptom constellation, which is characteristic of Gulf War Illness. Understanding these neuroimaging and neuropathological relationships in Gulf War and Iraq/Afghanistan veterans may improve clinical management and treatment strategies for modern war related chronic multisymptom illness.
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Affiliation(s)
- Yu Zhang
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Matthew Moore
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer S. Jennings
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - J. David Clark
- Anesthesiology Service, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Peter J. Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - J. Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Ansgar J. Furst
- War Related Illness and Injury Study Center, VA Palo Alto Health Care System, Palo Alto, CA, United States
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, United States
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2
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Hammerle MH, Lu LH, Thomas LC, Swan AA, Hoppes CW, Nelson JT, Treleaven JM. Possible autonomic or cranial nerve symptoms triggered during sustained neck rotation in persistent headache post-concussion: a retrospective observational cross-sectional study. J Man Manip Ther 2023; 31:113-123. [PMID: 35695356 PMCID: PMC10013563 DOI: 10.1080/10669817.2022.2085850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To examine and categorize symptoms occurring within 60 s of vertebrobasilar-insufficiency (VBI) testing (left- and right-neck rotation) in individuals with persistent post-traumatic headache. BACKGROUND As part of routine clinical cervical screening in our patients, we found extended VBI testing often triggered additional symptoms. Therefore, we aimed to document the prevalence and precise symptoms occurring during each movement direction of this test and determine any demographic or baseline signs or symptoms associated with a positive test. METHODS A retrospective medical record review on military personnel receiving treatment for persistent post-traumatic headache was performed. Participants were grouped according to presence of non-headache related symptoms triggered during the tests. Frequency, onset, and symptom characteristics reported were categorized as potentially vascular and/or possible autonomic or cranial nerve in nature. RESULTS At least one symptom was reported by 81.3% of 123 patients. Of these, 54% reported symptoms in one and 46% in both directions of rotation, yielding 146 abnormal tests. Most reported symptoms were tear disruption (41%), altered ocular-motor-control (25%), and blepharospasm (16%). Enlisted individuals and those with altered baseline facial sensation were more likely to have a positive test. CONCLUSIONS The majority reported symptoms not typical of VBI within 60 seconds of sustained neck rotation. Further study is needed to better understand the mechanisms and clinical relevance.
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Affiliation(s)
- Matt H Hammerle
- Brain Injury Rehabilitation Service, Brooke Army Medical Center, JBSA Fort Sam Houston, San Antonio, Texas, USA
| | - Lisa H Lu
- Defense and Veterans Brain Injury Center, JBSA Ft Sam Houston, San Antonio, Texas, USA
| | - Lucy C Thomas
- Neck Pain and Whiplash Research Unit, School of Health and Rehabilitation Services, University of Queensland, Brisbane Queensland, Australia
| | - Alicia A Swan
- Department of Psychology & South Texas Veterans Health Care System, the University of Texas at San Antonio, San Antonio, Texas, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, San Antonio, Texas, USA
| | - Jeremy T Nelson
- Department of Radiology and Imaging Sciences, Military Health Institute, the University of Texas Health Science Center at San Antonio & Indiana University, San Antonio, Texas, USA
| | - Julia M Treleaven
- Neck Pain and Whiplash Research Unit, School of Health and Rehabilitation Services, University of Queensland, Brisbane Queensland, Australia
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3
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Verne ZT, Fields JZ, Zhang BB, Zhou Q. Autonomic dysfunction and gastroparesis in Gulf War veterans. J Investig Med 2023; 71:7-10. [PMID: 35798472 DOI: 10.1136/jim-2021-002291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/25/2023]
Abstract
Over 25% of veterans with Gulf War illness developed chronic gastrointestinal (GI) symptoms of unknown etiology after they returned from deployment to the Persian Gulf. To determine the prevalence of delayed gastric emptying and its association with autonomic dysfunction in returning Gulf War (GW) veterans with chronic GI symptoms, we prospectively studied 35 veterans who were deployed to the Persian Gulf and developed chronic nausea, vomiting, postprandial abdominal pain, and bloating during their tour of duty and 15 asymptomatic controls. All veterans underwent 5 standardized cardiovascular tests to assess autonomic function. Each test was scored from 0 (normal) to 5 (severe disease) and the mean was calculated. A composite score >1.5 was considered abnormal, with 5 representing severe autonomic dysfunction. A standardized gastric emptying test with a solid phase was performed in each veteran. A gastric retention of >50% at 100 minutes was considered abnormal. The composite autonomic score was 3.7 in veterans with GI symptoms (vs 1.3 in controls) (p<0.01). The mean solid phase retention at 100 minutes was 72.6% in the symptomatic veterans versus 24.6% in controls (p<0.001). Our results suggest that autonomic dysfunction and delayed gastric emptying are common in returning GW veterans with GI symptoms. Autonomic dysfunction was positively correlated with the severity of delayed gastric emptying and may account for the GI symptoms of nausea, vomiting, postprandial abdominal pain, and bloating. These new findings are important for an increasing number of veterans who are serving in the Persian Gulf and are at a high risk of developing GI disorders while deployed.
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Affiliation(s)
| | - Jeremy Z Fields
- Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Benjamin Buyi Zhang
- Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - QiQi Zhou
- Department of Medicine, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA.,Memphis VA Medical Center, Memphis, Tennessee, USA
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Bayley PJ, Schulz-Heik RJ, Cho R, Mathersul D, Collery L, Shankar K, Ashford JW, Jennings JS, Tang J, Wong MS, Avery TJ, Stanton MV, Meyer H, Friedman M, Kim S, Jo B, Younger J, Mathews B, Majmundar M, Mahoney L. Yoga is effective in treating symptoms of Gulf War illness: A randomized clinical trial. J Psychiatr Res 2021; 143:563-571. [PMID: 33218747 DOI: 10.1016/j.jpsychires.2020.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/09/2020] [Accepted: 11/09/2020] [Indexed: 01/04/2023]
Abstract
Many Veterans of the 1990-1991 Gulf War report symptoms of Gulf War Illness, a condition involving numerous chronic symptoms including pain, fatigue, and mood/cognition symptoms. Little is known about this condition's etiology and treatment. This study reports outcomes from a randomized controlled single-blind trial comparing yoga to cognitive behavioral therapy for chronic pain and other symptoms of Gulf War Illness. Participants were Veterans with symptoms of GWI: chronic pain, fatigue and cognition-mood symptoms. Seventy-five Veterans were randomized to treatment via selection of envelopes from a bag (39 yoga, 36 cognitive behavioral therapy), which consisted of ten weekly group sessions. The primary outcomes of pain severity and interference (Brief Pain Inventory- Short Form) improved in the yoga condition (Cohen's d = .35, p = 0.002 and d = 0.69, p < 0.001, respectively) but not in the CBT condition (d = 0.10, p = 0.59 and d = 0.25 p = 0.23). However, the differences between groups were not statistically significant (d = 0.25, p = 0.25; d = 0.43, p = 0.076), though the difference in an a-priori-defined experimental outcome variable which combines these two variables into a total pain variable (d = 0.47, p = 0.047) was significant. Fatigue, as indicated by a measure of functional exercise capacity (6-min walk test) was reduced significantly more in the yoga group than in the CBT group (between-group d = .27, p = 0.044). Other secondary outcomes of depression, wellbeing, and self-reported autonomic nervous system symptoms did not differ between groups. No adverse events due to treatment were reported. Yoga may be an effective treatment for core Gulf War Illness symptoms of pain and fatigue, making it one of few treatments with empirical support for GWI. Results support further evaluation of yoga for treating veterans with Gulf War Illness. CLINICAL TRIAL REGISTRY: clinicaltrials.gov Registration Number NCT02378025.
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Affiliation(s)
- Peter J Bayley
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - R Jay Schulz-Heik
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Rachael Cho
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Danielle Mathersul
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Linda Collery
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | | | - J Wesson Ashford
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer S Jennings
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Julia Tang
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Melinda S Wong
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Timothy J Avery
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Hillary Meyer
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Palo Alto University, Palo Alto, CA, USA
| | - Marcelle Friedman
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA; Palo Alto University, Palo Alto, CA, USA
| | - Stephan Kim
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Booil Jo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Jarred Younger
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Louise Mahoney
- War Related Illness and Injury Study Center, VA Palo Alto Healthcare System, Palo Alto, CA, USA
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Kimono DA. Gastrointestinal problems, mechanisms and possible therapeutic directions in Gulf war illness: a mini review. Mil Med Res 2021; 8:50. [PMID: 34503577 PMCID: PMC8431926 DOI: 10.1186/s40779-021-00341-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 08/19/2021] [Indexed: 11/25/2022] Open
Abstract
By its nature, Gulf war illness (GWI) is multisymptomatic and affects several organ systems in the body. Along with other symptoms, veterans who suffer from GWI commonly report chronic gastrointestinal issues such as constipation, pain, indigestion, etc. However, until recently, most attention has been focused on neurological disturbances such as cognitive impairments, chronic fatigue, and chronic pain among affected veterans. With such high prevalence of gastrointestinal problems among Gulf war (GW) veterans, it is surprising that there is little research to investigate the mechanisms behind these issues. This review summarizes all the available works on the mechanisms behind gastrointestinal problems in GWI that have been published to date in various databases. Generally, these studies, which were done in rodent models, in vitro and human cohorts propose that an altered microbiome, a reactive enteric nervous system or a leaky gut among other possible mechanisms are the major drivers of gastrointestinal problems reported in GWI. This review aims to draw attention to the gastrointestinal tract as an important player in GWI disease pathology and a potential therapeutic target.
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Jaquess KJ, Allen N, Chun TJ, Crock L, Zajdel AA, Reinhard MJ, Costanzo ME. The relationship between Gulf War Illness symptom severity and heart rate variability: A pilot study. Life Sci 2021; 280:119663. [PMID: 34087286 DOI: 10.1016/j.lfs.2021.119663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Gulf War Illness (GWI) is a chronic multisymptom illness affecting 250,000+ veterans of the '90-'91 Gulf War which remains under-explored in terms of its physiological characteristics. We investigated whether subjective GWI symptom severity scores were related to objective measures of autonomic nervous system activity. METHODS We estimated activity in the two major branches of the autonomic nervous system (the parasympathetic nervous system [PNS] and the sympathetic nervous system [SNS]) via metrics of heart rate variability in a sample of Veterans who met established criteria for GWI with varying degrees of self-reported symptom severity. We hypothesized that subjective symptom severity scores would be inversely related to PNS activity and positively related to SNS activity. RESULTS Significant negative relationships were observed between the root mean square of successive differences of beat-to-beat intervals (a measure of PNS activity) and symptom severity, both overall and across specific GWI symptom categories (sp. fatigue [r = -0.574], gastrointestinal [r = -0.544]). Furthermore, significant positive relationships were observed between the cardiac sympathetic index and symptom severity, both overall and across specific symptom categories (sp. cognitive [r = 0.721], fatigue [r = 0.560], gastrointestinal [r = 0.694], skin [r = 0.686]). CONCLUSIONS Metrics of PNS activation revealed a negative relationship with self-reported symptom severity, while metrics of SNS activation revealed a positive relationship. The present results improve our understanding of the physiology of GWI and provide a new window from which to consider this medically unexplained illness.
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Affiliation(s)
- Kyle J Jaquess
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America; Department of Kinesiology, University of Maryland, College Park, MD, United States of America; Department of Psychology, Juniata College, Huntingdon, PA, United States of America.
| | - Nathaniel Allen
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America
| | - Timothy J Chun
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America
| | - Lucas Crock
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America
| | - Alexander A Zajdel
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America
| | - Matthew J Reinhard
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America; Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States of America
| | - Michelle E Costanzo
- War Related Illness and Injury Study Center, Department of Veterans Affairs Washington, DC, United States of America
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de Faria Cardoso C, Ohe NT, Bader Y, Afify N, Al-Homedi Z, Alwedami SM, O'Sullivan S, Campos LA, Baltatu OC. Heart Rate Variability Indices as Possible Biomarkers for the Severity of Post-traumatic Stress Disorder Following Pregnancy Loss. Front Psychiatry 2021; 12:700920. [PMID: 35058809 PMCID: PMC8763675 DOI: 10.3389/fpsyt.2021.700920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/02/2021] [Indexed: 12/30/2022] Open
Abstract
Background: Psychological distress, such as posttraumatic stress disorder (PTSD), is commonly evaluated using subjective questionnaires, a method prone to self-report bias. The study's working hypothesis was that levels of autonomic dysfunction determined by heart rate variability (HRV) measures are associated with the severity of PTSD in women following pregnancy loss. Methods: This was an observational prospective cohort study with 53 patients enrolled. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) PTSD scale (PCL-5) was used to assess the severity of PTSD in women after pregnancy loss. The cardiac autonomic function was assessed using HRV measurements during a deep breathing test using an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. HRV measures were: standard deviation (SD) of normal R-R wave intervals [SDNN, ms], square root of the mean of the sum of the squares of differences between adjacent normal R wave intervals [RMSSD, ms], and the number of all R-R intervals in which the change in consecutive normal sinus intervals exceeds 50 milliseconds divided by the total number of R-R intervals measured [pNN50 = (NN50/n-1)*100%] [pNN50%]. Results: The PCL-5 scores had a statistically significant association with HRV indices (SDNN; RMSSD, and pNN50%). Patients with PTSD had similar mean heart rate values as compared to patients without PTSD (PCL-5), but significantly higher SDNN [median[IQR, interquartile range]: 90.1 (69.1-112.1) vs. 52.5 (36.8-65.6)], RMSSD [59.4 (37.5-74.9) vs. 31.9 (19.3 - 44.0)], and PNN50% values [25.7 (16.4-37.7) vs. 10.6 (1.5-21.9)]. The SDNN of the deep breathing test HRV was effective at distinguishing between patients with PTSD and those without, with an AUC = 0.83 +/- 0.06 (95 % CI 0.94, p = 0.0001) of the ROC model. Conclusions: In this study, HRV indices as biomarkers of cardiac dysautonomia were found to be significantly related to the severity of PTSD symptoms in women after pregnancy loss.
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Affiliation(s)
- Cláudia de Faria Cardoso
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University, Sao Jose dos Campos, Brazil
| | - Natalia Tiemi Ohe
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University, Sao Jose dos Campos, Brazil
| | - Yazan Bader
- Emory University, Atlanta, GA, United States
| | - Nariman Afify
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Zahrah Al-Homedi
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Salma Malalla Alwedami
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Siobhán O'Sullivan
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Luciana Aparecida Campos
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University, Sao Jose dos Campos, Brazil.,College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ovidiu Constantin Baltatu
- Center of Innovation, Technology and Education (CITE), Anhembi Morumbi University, Sao Jose dos Campos, Brazil.,College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
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Gulf war illness, post-HPV vaccination syndrome, and Macrophagic Myofasciitis. Similar disabling conditions possibly linked to vaccine-induced autoimmune dysautonomia. Autoimmun Rev 2020; 19:102603. [DOI: 10.1016/j.autrev.2020.102603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023]
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Neurotoxicity in Gulf War Illness and the potential role of glutamate. Neurotoxicology 2020; 80:60-70. [DOI: 10.1016/j.neuro.2020.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/16/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023]
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Tuteja AK, Talley NJ, Stoddard GJ, Samore MH, Verne GN. Risk factors for upper and lower functional gastrointestinal disorders in Persian Gulf War Veterans during and post-deployment. Neurogastroenterol Motil 2019; 31:e13533. [PMID: 30697884 DOI: 10.1111/nmo.13533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/30/2018] [Accepted: 12/03/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gastroenteritis is a risk factor for irritable bowel syndrome (IBS), but its role in other functional gastrointestinal disorders (FGIDs) is less clear. The aim of this study was to determine the prevalence of FGIDs in Gulf War (GW) Veterans before, during, and after deployment and to determine whether gastroenteritis was a risk factor for upper and lower FGIDs. METHODS The Veterans who served during the Persian GW were mailed validated questionnaires inquiring about their bowel habits, psychological and extra-intestinal symptoms, and quality of life (QOL). The lactulose hydrogen breath test (LBT) was performed for small intestinal bacterial overgrowth. KEY RESULTS Data were analyzed from 468 GW Veterans. The prevalence of FGID before, during, and 16 years after deployment was 15.7%, 49.9%, and 64.2%, respectively. New FGIDs during deployment was reported by 41.2%, and during 16 years after deployment, 43.7% acquired new FGIDs. FGIDs were associated with psychological disorders, extra-intestinal symptoms, and lower QOL. Gastroenteritis was reported by 44.3% of deployed Veterans and was a risk factor for IBS, dyspepsia, and functional diarrhea post-deployment. The cases and controls did not differ significantly in the frequency of positive LBT. CONCLUSIONS AND INFERENCES There is an increase in the prevalence of FGIDs during deployment, and it persists after deployment. There is a further increase in the prevalence of FGIDs after deployment. In addition to IBS, gastroenteritis during deployment is a risk factor for dyspepsia and functional diarrhea post-deployment. Therefore, prevention of gastroenteritis during deployment and screening of Veterans for FGIDs post-deployment would be of value for Veterans' long-term health.
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Affiliation(s)
- Ashok K Tuteja
- George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah.,Division of Gastroenterology, University of Utah, Salt Lake City, Utah
| | | | | | - Matthew H Samore
- George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah
| | - G Nicholas Verne
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.,North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, Florida
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