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Lee KS, Song IS, Kim ES, Kim J, Jung S, Nam S, Ahn KH. Machine learning analysis with population data for the associations of preterm birth with temporomandibular disorder and gastrointestinal diseases. PLoS One 2024; 19:e0296329. [PMID: 38165877 PMCID: PMC10760735 DOI: 10.1371/journal.pone.0296329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 01/04/2024] Open
Abstract
This study employs machine learning analysis with population data for the associations of preterm birth (PTB) with temporomandibular disorder (TMD) and gastrointestinal diseases. The source of the population-based retrospective cohort was Korea National Health Insurance claims for 489,893 primiparous women with delivery at the age of 25-40 in 2017. The dependent variable was PTB in 2017. Twenty-one predictors were included, i.e., demographic, socioeconomic, disease and medication information during 2002-2016. Random forest variable importance was derived for finding important predictors of PTB and evaluating its associations with the predictors including TMD and gastroesophageal reflux disease (GERD). Shapley Additive Explanation (SHAP) values were calculated to analyze the directions of these associations. The random forest with oversampling registered a much higher area under the receiver-operating-characteristic curve compared to logistic regression with oversampling, i.e., 79.3% vs. 53.1%. According to random forest variable importance values and rankings, PTB has strong associations with low socioeconomic status, GERD, age, infertility, irritable bowel syndrome, diabetes, TMD, salivary gland disease, hypertension, tricyclic antidepressant and benzodiazepine. In terms of max SHAP values, these associations were positive, e.g., low socioeconomic status (0.29), age (0.21), GERD (0.27) and TMD (0.23). The inclusion of low socioeconomic status, age, GERD or TMD into the random forest will increase the probability of PTB by 0.29, 0.21, 0.27 or 0.23. A cutting-edge approach of explainable artificial intelligence highlights the strong associations of preterm birth with temporomandibular disorder, gastrointestinal diseases and antidepressant medication. Close surveillance is needed for pregnant women regarding these multiple risks at the same time.
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Affiliation(s)
- Kwang-Sig Lee
- AI Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - In-Seok Song
- Department of Oral and Maxillofacial Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Eun Sun Kim
- Department of Gastroenterology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Jisu Kim
- AI Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
- Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Sohee Jung
- AI Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
- Department of Statistics, Korea University College of Political Science and Economics, Seoul, Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Sunwoo Nam
- AI Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Ki Hoon Ahn
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
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Sekizuka H, Miyake H. Relationship between nonrestorative sleep and heartburn among a Japanese occupational population. Indian J Gastroenterol 2023; 42:542-548. [PMID: 37355485 DOI: 10.1007/s12664-023-01366-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/04/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Nonrestorative sleep (NRS) is a symptom of insomnia and is clearly more associated with objective indices than other insomnia symptoms. Gastroesophageal reflux disease (GERD) and insomnia are known to be strongly related. However, the link between NRS and heartburn, a main symptom of GERD, is poorly understood. Therefore, the relationships between them were investigated in addition to sleep duration. METHODS The results of a single year's medical examinations were investigated for 29,475 Japanese active office workers who were 20 to 59 years old. NRS and heartburn were investigated in a medical interview using a personal computer. The relationships between NRS and heartburn in addition to sleep duration were also analyzed. RESULTS The subjects were 46.6 ± 8.7 years old (mean ± SD) and 27% and 13% of them had NRS and heartburn, respectively. The presence of NRS together with a sleep duration of ≤ 5, 6, 7 or ≥ 8 hours was an independent comorbid factor for heartburn compared with the absence of NRS together with a sleep duration of seven hours (reference; odds ratio [OR], 2.38; 95% confidence interval [CI], 2.11-2.69, OR, 2.44; 95% CI, 2.16-2.76, OR, 2.33; 95% CI, 1.94-2.79; and OR, 1.72; 95% CI, 1.14-2.52). The absence of NRS together with a sleep duration of ≤ 5 hours was also an independent comorbid factor for heartburn compared with the reference (OR, 1.20; 95% CI, 1.05-1.37). CONCLUSIONS NRS in active workers may contribute to heartburn comorbidity despite the sleep duration as in other workers without NRS.
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Affiliation(s)
- Hiromitsu Sekizuka
- Department of Internal Medicine, Fujitsu Clinic, Kawasaki City, 4-1-1 Kamikodanaka, Nakahara-Ku, Kanagawa Prefecture, 211-8588, Japan.
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan.
| | - Hitoshi Miyake
- Health Promotion Unit, Fujitsu Limited, Kawasaki, Kanagawa, Japan
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Malhotra D, Boyle SH, Gifford EJ, Sullivan BA, Nguyen Wenker TH, Abs ND, Ahmed ST, Upchurch J, Vahey J, Stafford C, Efird JT, Hunt SC, Bradford A, Sims KJ, Hauser ER, Helmer DA, Williams CD. Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder. Neurogastroenterol Motil 2023; 35:e14548. [PMID: 36942766 DOI: 10.1111/nmo.14548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 11/08/2022] [Accepted: 01/11/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans. METHODS Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). KEY RESULTS The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aORIBS = 3.12, 95% CI: 1.93-5.05; aORGERD = 2.04, 95% CI: 1.44-2.90; aORCP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aORIBS = 4.38, 95% CI: 1.55-12.36; aORGERD = 2.51 95% CI: 1.63-3.87; aORCP = 2.57, 95% CI: 1.53-4.32). CONCLUSIONS & INFERENCES GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.
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Affiliation(s)
- D Malhotra
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - S H Boyle
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E J Gifford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA
| | - B A Sullivan
- Duke University School of Medicine, Durham, North Carolina, USA
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - T H Nguyen Wenker
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - Nono-Djotsa Abs
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
- Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA
| | - S T Ahmed
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - J Upchurch
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J Vahey
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - C Stafford
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - J T Efird
- VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA
- Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - S C Hunt
- VA Puget Sound Health Care System, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - A Bradford
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - K J Sims
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
| | - E R Hauser
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA
| | - D A Helmer
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - C D Williams
- Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA
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Miao Y, Yuan S, Li Y, Chen J, Li X, Larsson SC, Zhang Q. Bidirectional Association between Major Depressive Disorder and Gastroesophageal Reflux Disease: Mendelian Randomization Study. Genes (Basel) 2022; 13:genes13112010. [PMID: 36360247 PMCID: PMC9690029 DOI: 10.3390/genes13112010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Observational research has found a bidirectional relationship between major depressive disorder and gastroesophageal reflux disease; however, the causal association of this relationship is undetermined. AIMS A bidirectional Mendelian randomization study was performed to explore the causal relationships between major depressive disorder and gastroesophageal reflux disease. METHODS For the instrumental variables of major depressive disorder and gastroesophageal reflux disease, 31 and 24 single-nucleotide polymorphisms without linkage disequilibrium (r2 ≤ 0.001) were selected from relevant genome-wide association studies, respectively, at the genome-wide significance level (p ≤ 5 × 10-8). We sorted summary-level genetic data for major depressive disorder, gastroesophageal reflux disease, gastroesophageal reflux disease without esophagitis, and reflux esophagitis from meta-analysis study of genome-wide association studies involving 173,005 individuals (59,851 cases and 113,154 non-cases), 385,276 individuals (80,265 cases and 305,011 non-cases), 463,010 individuals (4360 cases and 458,650 non-cases), and 383,916 individuals (12,567 cases and 371,349 non-cases), respectively. RESULTS Genetic liability to major depressive disorder was positively associated with gastroesophageal reflux disease and its subtypes. Per one-unit increase in log-transformed odds ratio of major depressive disorder, the odds ratio was 1.31 (95% confidence interval [CI], 1.19-1.43; p = 1.64 × 10-8) for gastroesophageal reflux disease, 1.51 (95% CI, 1.15-1.98; p = 0.003) for gastroesophageal reflux disease without esophagitis, and 1.21 (95% CI, 1.05-1.40; p = 0.010) for reflux esophagitis. Reverse-direction analysis suggested that genetic liability to gastroesophageal reflux disease was causally related to increasing risk of major depressive disorder. Per one-unit increase in log-transformed odds ratio of gastroesophageal reflux disease, the odds ratio of major depressive disorder was 1.28 (95% confidence interval, 1.11-1.47; p = 1.0 × 10-3). CONCLUSIONS This Mendelian randomization study suggests a bidirectional causal relationship between major depressive disorder and gastroesophageal reflux disease.
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Affiliation(s)
- Yuyang Miao
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Ye Li
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
| | - Jie Chen
- Centre for Global Health, Zhejiang University School of Medicine, Hangzhou 310030, China
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha 410017, China
| | - Xue Li
- School of Public Health and the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310030, China
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Susanna C. Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
- Unit of Medical Epidemiology, Department of Surgical Sciences, Uppsala University, 75236 Uppsala, Sweden
- Correspondence: (S.C.L.); (Q.Z.)
| | - Qiang Zhang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin 300052, China
- Tianjin Geriatrics Institute, Tianjin 300052, China
- Correspondence: (S.C.L.); (Q.Z.)
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Chiu YC, Chang WP, Tang GJ, Lan TY, Lee KY, Su VYF. Chronic obstructive pulmonary disease is associated with a higher risk of functional gastrointestinal disorders. Respir Med 2022; 197:106833. [DOI: 10.1016/j.rmed.2022.106833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
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Odah MM, Ewis AA, Alessi AA, Alhasani TM, Alghanmi AA, Almarhabi AA, Almuashi IM, Almathami AA, Alfakieh HO, Alkudaysi FM, Alnashri IA, Alnashri HI, Awad MA, Alammari MS, Alessa AA. Prevalence of Gastroesophageal Disease and Associated Risk Factors Among the Population in Al-Qunfudah. Cureus 2021; 13:e20325. [PMID: 34909354 PMCID: PMC8663801 DOI: 10.7759/cureus.20325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/23/2022] Open
Abstract
Background and objective Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal diseases worldwide. It causes an unpleasant effect on patients' lives and may lead to serious complications resulting in a significant burden on healthcare systems. Despite being a common gastrointestinal disease, very few studies have been conducted on the condition in Saudi Arabia; and there has never been a study to estimate the prevalence of GERD in the Al-Qunfudah Governorate. In light of this, we conducted this study with an aim to assess the prevalence of GERD and its associated risk factors among the Al-Qunfudah population. Methods A cross-sectional study was conducted in the Al-Qunfudah Governorate by using an online self-administrated questionnaire that was shared through social media during the first week of January 2021. The questionnaire consisted of a general section on sociodemographic data and a section on the diagnosis of GERD based on the validated gastroesophageal reflux disease questionnaire (GERD-Q). A total of 1,180 eligible participants responded to the questionnaire. Results Nearly one-third (32.9%) of the study participants had GERD based on their reported symptoms and calculated scores (GERD-Q score ≥8). About 14.8% of the participants (175/1,180) reported that they had already been diagnosed with GERD before their participation in our survey. Regarding risk factors of GERD, about 35% reported experiencing psychological stress, 28.3% had a family member diagnosed with GERD, and 18.1% were smokers; 49.4% of the participants had their symptoms aggravated by consuming fatty or fried food and 46.7% by spicy food. One of the factors that helped to relieve GERD symptoms was avoiding symptom-aggravating food, as reported by more than half (50.7%) of the participants. Conclusion The prevalence of GERD in the Al-Qunfudah population is high as the condition has affected one-third of the adult population. Our study confirms that male gender, age of 30 years or above, being overweight or obese, being married, smoking habit, use of non-steroidal anti-inflammatory drugs (NSAIDs), having psychological stress, being asthmatic, or having a family history of GERD are factors that significantly increase the likelihood of developing GERD. The reported risk factors include experiencing psychological stress, a family history of GERD, high BMI, and smoking.
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Affiliation(s)
- Mosad M Odah
- Biochemistry, Umm Al-Qura University, Al-Qunfudah, SAU
| | - Ashraf A Ewis
- Public Health, Umm Al-Qura University, Al-Qunfudah, SAU
| | - Awad A Alessi
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | - Ali A Alghanmi
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | | | - Ali A Almathami
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | | | | | | | - Mohammed A Awad
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
| | | | - Adnan A Alessa
- Medicine and Surgery, Umm Al-Qura University, Al-Qunfudah, SAU
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Broers C, Geeraerts A, Boecxstaens V, Van Houtte B, Geysen H, Peersman N, Vermeersch P, Vanuytsel T, Tack J, Pauwels A. The role of serotonin in the control of esophageal sensitivity assessed by multimodal stimulation in health. Neurogastroenterol Motil 2021; 33:e14057. [PMID: 33280212 DOI: 10.1111/nmo.14057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/22/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Esophageal hypersensitivity is considered an important pathophysiological mechanism in refractory gastroesophageal reflux disease (GERD) patients. Serotonin (5-HT) plays an important role in the regulation of GI (gastrointestinal) secretion, motility and sensitivity. Previous studies found that altered 5-HT availability has no clear effects on esophageal/GI sensations. Our aim was therefore to investigate the role of 5-HT in esophageal sensitivity in healthy volunteers (HV). METHODS Esophageal sensitivity to thermal, mechanical, electrical, and chemical stimuli was assessed in 3 different placebo-controlled studies. In the first study, the effect of citalopram (40 mg; 5-HT reuptake inhibitor; intravenous) was investigated (n = 14). In the second study, the effect of buspirone (20 mg; 5HT1A agonist; oral) was investigated (n = 10). In the third study, acute tryptophan depletion (ATD) was used to decrease 5-HT levels to investigate the effect of reduced 5-HT availability on esophageal sensitivity (n = 15). KEY RESULTS No difference was observed in esophageal sensitivity after the administration of citalopram or buspirone (all p > 0.06). In contrast, pain perception threshold to chemical stimulation was increased after ATD (p = 0.017, Cohen's d+ = 0.67). No effect was found on the first perception or pain tolerance threshold. ATD had no influence on esophageal sensitivity to thermal, mechanical, and electrical stimulation compared with placebo. CONCLUSIONS AND INFERENCES ATD, which induces 5-HT depletion, significantly decreased pain perception threshold during chemical stimulation, without affecting sensitivity to mechanical, thermal, or electrical stimulation. These findings confirm the involvement of 5-HT in the control of esophageal acid sensitivity, but identifying the receptors involved requires more ligands and studies.
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Affiliation(s)
- Charlotte Broers
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Annelies Geeraerts
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Veerle Boecxstaens
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Brecht Van Houtte
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Hannelore Geysen
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Nele Peersman
- Clinical Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Pieter Vermeersch
- Clinical Department of Laboratory Medicine, University Hospital Leuven, Leuven, Belgium
| | - Tim Vanuytsel
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Jan Tack
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
| | - Ans Pauwels
- Translational Research Centre for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium
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Kropochev VS, Morozov SV, Lantseva MA, Sasunova AN, Pilipenko VI, Isakov VA. [Food patterns in Russian patients with gastroesophageal reflux disease: the results of pilot comparative study]. TERAPEVT ARKH 2020; 92:66-72. [PMID: 33346464 DOI: 10.26442/00403660.2020.08.000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Indexed: 02/07/2023]
Abstract
AIM To evaluate nutritional patterns in patients with gastroesophageal reflux disease (GERD) compared to the control group without GERD. MATERIALS AND METHODS The data of complex examination of patients referred to perform esophageal pH-impedance recording and who gave written informed consent to participate in the study served as a source data. All the participants underwent complex examination, including clinical data (presence of heartburn and acid regurgitation), symptom evaluation (GERD-Q questionnaire), esophagogastroscopy, esophageal pH-impedance recordings and food frequency questionnaire. Diagnosis of GERD was based on GERD-Q score 8, acid exposure time 6%, number of gastroesophageal refluxes 80/day by 24-hrs esophageal pH-impedance recordings. Nutritional patterns were assessed with the use of healthy eating pyramid principles. RESULTS Overall 165 patients were enrolled and the data of 150 of them (34 with confirmed GERD and 116 of the control group) were available for the final analysis. The patients of the both groups consumed lower compared to the recommended amounts of dairy and higher amounts of meat. Those with GERD consumed larger amounts of fruits (0.910.68 compared to the values of healthy eating pyramid vs 0.520.57 in the control group, p=0.001), and fats (0.690.55 vs 0.490.55, p=0.001). Compared to the controls, patients with GERD consumed lower amounts of vegetables (0.860.46 of the healthy eating pyramid vs 0.940.63 in the control group, р=0.004) and sugars confectionaries (0.380.39 vs 1.930.98, p=0.0001). CONCLUSION Nutritional patterns of patients with gastroesophageal reflux disease significantly differ compared to the control group. The obtained data may be used for diet modification in patients with arterial hypertension.
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Affiliation(s)
- V S Kropochev
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - S V Morozov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - M A Lantseva
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - A N Sasunova
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - V I Pilipenko
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
| | - V A Isakov
- Federal Research Centre of Nutrition, Biotechnology and Food Safety
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Madison AA, Woody A, Bailey B, Lustberg MB, Ramaswamy B, Wesolowski R, Williams N, Reinbolt R, VanDeusen JB, Sardesai S, Malarkey WB, Kiecolt-Glaser JK. Cognitive problems of breast cancer survivors on proton pump inhibitors. J Cancer Surviv 2020; 14:226-234. [PMID: 31933149 PMCID: PMC7183896 DOI: 10.1007/s11764-019-00815-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/01/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Proton pump inhibitors (PPIs) are used in cancer patients to manage treatment-related gastrointestinal symptoms and to prevent damage to the gastric mucosal lining during treatment. However, PPI use may contribute to cognitive problems. To compare PPI-users and non-users, breast cancer survivors reported cognitive problems in three studies. METHODS In Study 1, breast cancer survivors (N = 209; n = 173 non-users, n = 36 PPI-users; stages 0-IIIC) rated their cognitive function on the Kohli scale prior to cancer treatment, as well as one and two years later. In Study 2, women (N = 200; n = 169 non-users, n = 31 PPI-users, stages 0-IIIa, M = 11 months post-treatment) rated their cognitive function on the Kohli scale and BCPT checklist at three visits over a six-month period. In Study 3, participants (N = 142; n = 121 non-users, n = 21 PPI-users; stages I-IIIa, M = 4 years post-treatment) rated their cognitive function on the Kohli scale, BCPT checklist, and Functional Assessment of Cancer Therapy cognitive scale (FACT-cog). RESULTS In Study 1, PPI-users reported more severe concentration problems (p = 0.039) but not memory problems (p = 0.17) than non-users. In Study 2, PPI-users reported more severe concentration problems (p = 0.022) than non-users, but not memory problems or symptoms on the BCPT (ps = 0.11). Study 3's PPI-users reported more severe memory problems (p = 0.002), poorer overall cognitive function (p = 0.006), lower quality of life related to cognitive problems (p = 0.005), greater perceived cognitive impairment (p = 0.013), and poorer cognitive abilities (p = 0.046), but not more severe concentration problems (p = 0.16), compared to non-users. CONCLUSIONS/IMPLICATIONS PPI use may impair breast cancer survivors' memory, concentration, and quality of life.
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Affiliation(s)
- Annelise A Madison
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
- Department of Psychology, The Ohio State University, 1835 Neil Avenue, Columbus, OH, 43210, USA
| | - Alex Woody
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Brittney Bailey
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
| | - Maryam B Lustberg
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Bhuvaneswari Ramaswamy
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Robert Wesolowski
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Nicole Williams
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Raquel Reinbolt
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Jeffrey B VanDeusen
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - Sagar Sardesai
- The Ohio State University Comprehensive Cancer Center, 4460 West 10th Avenue, Columbus, OH, 43210, USA
| | - William B Malarkey
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA
- Department of Internal Medicine, The Ohio State University, 395 West 12th Avenue, Columbus, OH, 43210, USA
| | - Janice K Kiecolt-Glaser
- Institute for Behavioral Medicine Research, The Ohio State University, 460 Medical Center Drive, Columbus, OH, 43210, USA.
- Department of Psychiatry and Behavioral Health, The Ohio State University, 1670 Upham Drive, Columbus, OH, 43210, USA.
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Impact of psychiatric disorders on patient satisfaction after Nissen Fundoplication. Surg Endosc 2019; 34:1829-1834. [PMID: 31410627 DOI: 10.1007/s00464-019-06949-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anxiety and depression have been associated with an increased perception of gastroesophageal reflux symptoms, but there is a paucity of data regarding the outcomes of laparoscopic Nissen Fundoplication (LNF) in this patient population. METHODS We performed a retrospective cohort study including all patients undergoing LNF between 2011 and 2017. Patients were stratified by baseline usage of serotonin-modulating medication or benzodiazepines as a proxy for depression and anxiety, respectively. Outcome measures included postoperative gastroesophageal health-related quality of life (GERD-HRQL) scores and overall satisfaction rates after surgery. A p value of < 0.05 was considered statistically significant. RESULTS The population consisted of 271 patients of which 103 patients had depression and 44 patients had anxiety. Patients with depression reported no significant difference in pre- or postoperative GERD-HRQL scores compared to patients without depression and long-term satisfaction rates after surgery were similar in both groups at 76% vs 71%, respectively (p = 0.55). Patients with anxiety reported higher baseline HRQL scores (34 vs. 29, p = 0.05). At long-term follow-up (15 months), patients with anxiety reported slightly worse HRQL scores compared to controls (7 vs. 4, p = 0.11) despite no difference in usage of anti-acid medications or need for endoscopic dilations between the two groups. Patients with anxiety were less likely to report being "satisfied" after surgery (40% vs. 71%, p = 0.01) compared to controls. CONCLUSION Patients with anxiety have higher subjective reporting of GERD symptoms and are more likely to report being "satisfied" during long-term follow-up after LNF. Patients on medication for depression appear to have similar reporting of GERD symptoms and derive as much benefit from LNF as patients that are not. While LNF does improve the symptom burden in patients with anxiety, satisfaction is rarely achieved in long-term follow-up.
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Stocks NP, Gonzalez-Chica D, Hay P. Impact of gastrointestinal conditions, restrictive diets and mental health on health-related quality of life: cross-sectional population-based study in Australia. BMJ Open 2019; 9:e026035. [PMID: 31253614 PMCID: PMC6609067 DOI: 10.1136/bmjopen-2018-026035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the relationship between gastrointestinal conditions, restrictive diets, mental health and health-related quality of life (HRQoL). DESIGN Cross-sectional population-based face-to-face survey. SETTING South Australia. PARTICIPANTS A representative sample of 2912 consenting adults (48.9±18.1 years; 50.9% females) investigated in 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Participants self-reported diagnosis of gastrointestinal conditions, mental health and current use of restrictive diets. The physical component score (PCS) and mental component score (MCS) of HRQoL were investigated (Study Short Form 12 V.1 questionnaire). Linear regression models were used to test the associations, adjusting for (1) sociodemographic variables, (2) mental health status and (3) lifestyle and body mass index. RESULTS The prevalence of restrictive diets (36.1%; 95% CI 33.9 to 38.3) was higher among those with any self-reported gastrointestinal condition (60.7% vs 31.3% for those without these conditions; p<0.001). PCS was lower among those with a gastrointestinal condition (mean difference=-3.4; 95% CI -4.5 to -2.4) or on a restrictive diet (mean difference=-1.9; 95% CI -2.7 to -1.1), with a similar pattern, but with a smaller effect, observed for MCS. Being on a restrictive diet did not modify the relationship between having a gastrointestinal condition and reduced HRQoL. However, having a gastrointestinal condition was associated with a 2.4 points lower PCS (95% CI -3.5 to -1.3) among those without a mental health problem, while for those affected by a mental health condition this reduction was greater (mean difference=-5.9; 95% CI -8.7 to -3.1). For MCS, there was no evidence of interaction between mental health and gastrointestinal conditions. CONCLUSIONS One-third of Australian adults are restricting their diet, and this is associated with lower HRQoL. Being on a restrictive diet was not associated with a better HRQoL among individuals with a gastrointestinal condition. Mental health problems were associated with a stronger adverse relationship between gastrointestinal diseases and physical HRQoL. Health professionals should be alert to these associations when trying to improve health outcomes for patients.
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Affiliation(s)
- Nigel P Stocks
- General Practice, University of Adelaide, Adelaide, South Australia, Australia
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
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Gyawali CP, Fass R. Management of Gastroesophageal Reflux Disease. Gastroenterology 2018; 154:302-318. [PMID: 28827081 DOI: 10.1053/j.gastro.2017.07.049] [Citation(s) in RCA: 170] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/29/2017] [Accepted: 07/31/2017] [Indexed: 02/06/2023]
Abstract
Management of gastroesophageal reflux disease (GERD) commonly starts with an empiric trial of proton pump inhibitor (PPI) therapy and complementary lifestyle measures, for patients without alarm symptoms. Optimization of therapy (improving compliance and timing of PPI doses), or increasing PPI dosage to twice daily in select circumstances, can reduce persistent symptoms. Patients with continued symptoms can be evaluated with endoscopy and tests of esophageal physiology, to better determine their disease phenotype and optimize treatment. Laparoscopic fundoplication, magnetic sphincter augmentation, and endoscopic therapies can benefit patients with well-characterized GERD. Patients with functional diseases that overlap with or mimic GERD can also be treated with neuromodulators (primarily antidepressants), or psychological interventions (psychotherapy, hypnotherapy, cognitive and behavioral therapy). Future approaches to treatment of GERD include potassium-competitive acid blockers, reflux-reducing agents, bile acid binders, injection of inert substances into the esophagogastric junction, and electrical stimulation of the lower esophageal sphincter.
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Affiliation(s)
- C Prakash Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri
| | - Ronnie Fass
- Division of Gastroenterology and Hepatology, Esophageal and Swallowing Center, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio.
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Psychological Comorbidity and Chronic Heartburn: Which Is the Chicken and Which Is the Egg? Dig Dis Sci 2017; 62:823-825. [PMID: 28205110 DOI: 10.1007/s10620-017-4475-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 01/24/2017] [Indexed: 12/09/2022]
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Lee HS, Noh CK, Lee KJ. The Effect of Acute Stress on Esophageal Motility and Gastroesophageal Reflux in Healthy Humans. J Neurogastroenterol Motil 2017; 23:72-79. [PMID: 28049863 PMCID: PMC5216637 DOI: 10.5056/jnm16119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 10/03/2016] [Accepted: 10/18/2016] [Indexed: 12/16/2022] Open
Abstract
Background/Aims Little research has been done to evaluate the effect of stress in exacerbating the symptoms associated with gastroesophageal reflux (GER). We aimed to investigate the effect of acute stress on esophageal motility and GER parameters in healthy volunteers. Methods A total of 10 (M:F = 8:2, median age 34 years-old) healthy volunteers without any recurrent gastrointestinal symptoms participated in this study. They underwent esophageal high-resolution manometry with 10 wet swallows (Experiment I) and esophageal impedance-pH monitoring (Experiment II) in the basal period and in the stress period. In the stress period, either real stress or sham stress was given in a randomized cross-over design. The stress scores, symptom severity, and pulse rates were measured. Results The stress scores and the severity of nausea were significantly greater under real stress, compared with sham stress. The percentages of weak, failed, rapid, premature, and hyper-contractile contractions were not significantly altered during real stress and during sham stress, compared with the basal period. The median resting pressure of the lower esophageal sphincter and distal contractile integral of esophageal contractions did not differ in the stress period, compared with the basal period. Contractile front velocity and distal latency of esophageal peristaltic contractions were significantly changed during real stress, which was not observed during sham stress. GER parameters were not significantly altered during real stress and during sham stress. Conclusion Although acute auditory and visual stress seems to affect esophageal body motility, it does not induce significant motor abnormalities or increase GER in healthy humans.
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Affiliation(s)
- Hong Sub Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea.,Department of Gastroenterology, Seonam University College of Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Korea
| | - Chung Kyun Noh
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
| | - Kwang Jae Lee
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
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Fu MJ, Zhu LY. Risk factors for gastroesophageal reflux disease. Shijie Huaren Xiaohua Zazhi 2016; 24:2654-2660. [DOI: 10.11569/wcjd.v24.i17.2654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastroesophageal reflux disease, a common disease of the digestive tract that can be caused by various factors, seriously harms the patients' life quality due to the repeated episodes. Here we discuss the risk factors for gastroesophageal reflux disease, in order to assist in the prevention and treatment of the disease.
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Ho CE, Goh YL, Zhao XX, Yu CY, Zhang C. GERD: An Alternative Perspective. PSYCHOSOMATICS 2016; 57:142-51. [DOI: 10.1016/j.psym.2015.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 12/15/2022]
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Vakil N, Niklasson A, Denison H, Rydén A. Gender differences in symptoms in partial responders to proton pump inhibitors for gastro-oesophageal reflux disease. United European Gastroenterol J 2015; 3:443-52. [PMID: 26535123 DOI: 10.1177/2050640614558343] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gender differences may exist in the symptom experience of patients with gastro-oesophageal reflux disease (GERD) who have a partial response to proton pump inhibitors (PPIs). OBJECTIVE The purpose of this study was to analyse gender differences in partial responders to PPIs. METHODS Patients with GERD who responded partially to PPIs (n = 580; NCT00703534) completed the Reflux Symptom Questionnaire 7-day recall (RESQ-7) and the Gastrointestinal Symptom Rating Scale (GSRS). Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale. RESULTS Women had significantly higher RESQ-7 domain scores than men for Heartburn (frequency: 4.3 vs 3.9; intensity: 3.1 vs 2.8), Burping (frequency: 4.9 vs 4.4; intensity: 3.1 vs 2.8) and Hoarseness, cough and difficulty swallowing (frequency: 2.6 vs 2.2; intensity: 1.8 vs 1.5), and had higher GSRS domain discomfort scores than men for Abdominal pain (3.51 vs 3.23), Indigestion (3.80 vs 3.45) and Constipation (2.69 vs 2.17) (all p < 0.05). Anxiety and depression were significantly more prevalent in women than in men. CONCLUSION In this population of partial responders, women had more frequent/intense heartburn and extra-oesophageal symptoms and more discomfort from abdominal pain, indigestion and constipation than men. Comorbid anxiety and depression may contribute to the increased symptom burden in women.
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Affiliation(s)
- N Vakil
- University of Wisconsin Medical School and Public Health, Madison, USA
| | | | | | - A Rydén
- AstraZeneca R&D, Mölndal, Sweden
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Parekh PJ, Johnson DA. Medical treatment versus surgery for treatment of gastroesophageal reflux disease. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2015. [DOI: 10.1016/j.tgie.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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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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Biopsychosocial predictors of psychogenic non-epileptic seizures. Epilepsy Res 2014; 108:1543-53. [PMID: 25262500 DOI: 10.1016/j.eplepsyres.2014.09.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/22/2014] [Accepted: 09/06/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies have identified numerous biological, psychological and social characteristics of persons with psychogenic non-epileptic seizures (PNES) however the strength of many of these factors have not been evaluated to determine which are predictive of the diagnosis compared to those that may only be stereotypes with limited clinical utility. METHOD A retrospective chart review of persons admitted to our epilepsy monitoring unit over a 6-year period was conducted to examine predictors of a video-EEG confirmed PNES diagnosis. RESULTS A total of 689 patients had events leading to a diagnosis, 47% (n=324) with PNES only, 12% (n=84) with PNES & Epilepsy and 41% (n=281) with Epilepsy only. Five biological predictors of a PNES only diagnosis were found; number of years with events (OR=1.10), history of head injury (OR=1.91), asthma (OR=2.94), gastro-esophageal reflux disease (OR=1.72) and pain (OR=2.25). One psychological predictor; anxiety (OR=1.72) and two social predictors; being married (OR=1.81) and history of physical/sexual abuse (OR=3.35). Two significant biological predictors of a PNES & Epilepsy diagnosis were found; migraine (OR=1.83) and gastro-esophageal reflux disease (OR=2.17). CONCLUSIONS Our findings support the importance of considering the biopsychosocial model for the diagnosis and treatment of PNES or PNES with concomitant epilepsy.
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Abstract
There has been a marked decline over the last several years in drug development for gastroesophageal reflux disease and specifically for nonerosive reflux disease (NERD), despite there being many areas of unmet need. In contrast, we have seen a proliferation, during the same period of time, in development of novel, nonmedical therapeutic strategies for NERD using cutting-edge technology. Presently, compliance and lifestyle modifications are readily available noninvasive therapeutic interventions for NERD. Other nonmedical therapies include, the Stretta procedure, transoral incisionless fundoplication, and the magnetic sphincter augmentation device (LINX). Antireflux surgery, in experienced hands, has been repeatedly shown to be efficacious in resolving NERD-related symptoms. Psychological therapeutic interventions and alternative medicine techniques, such as acupuncture, continue to show promise, especially in NERD patients who failed antireflux treatment.
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Abstract
Although the idea that gastric problems are in some way related to mental activity dates back to the beginning of the last century, until now it has received scant attention by physiologists, general practitioners and gastroenterologists. The major breakthrough in understanding the interactions between the central nervous system and the gut was the discovery of the enteric nervous system (ENS) in the 19th century. ENS (also called 'little brain') plays a crucial role in the regulation of the physiological gut functions. Furthermore, the identification of corticotropin-releasing factor (CRF) and the development of specific CRF receptor antagonists have permitted to characterize the neurochemical basis of the stress response. The neurobiological response to stress in mammals involves three key mechanisms: (1) stress is perceived and processed by higher brain centers; (2) the brain mounts a neuroendocrine response by way of the hypothalamic-pituitary-adrenal axis (HPA) and the autonomic nervous system (ANS), and (3) the brain triggers feedback mechanisms by HPA and ANS stimulation to restore homeostasis. Various stressors such as anger, fear, painful stimuli, as well as life or social learning experiences affect both the individual's physiologic and gastric function, revealing a two-way interaction between brain and stomach. There is overwhelming experimental and clinical evidence that stress influences gastric function, thereby outlining the pathogenesis of gastric diseases such as functional dyspepsia, gastroesophageal reflux disease and peptic ulcer disease. A better understanding of the role of pathological stressors in the modulation of disease activity may have important pathogenetic and therapeutic implications.
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Affiliation(s)
- Gerardo Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Prados-Torres A, Calderón-Larrañaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol 2014; 67:254-66. [PMID: 24472295 DOI: 10.1016/j.jclinepi.2013.09.021] [Citation(s) in RCA: 472] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The aim of this review was to identify studies on patterns of associative multimorbidity, defined as the nonrandom association between diseases, focusing on the main methodological features of the studies and the similarities among the detected patterns. STUDY DESIGN AND SETTING Studies were identified through MEDLINE and EMBASE electronic database searches from their inception to June 2012 and bibliographies. RESULTS The final 14 articles exhibited methodological heterogeneity in terms of the sample size, age and recruitment of study participants, the data source, the number of baseline diseases considered, and the statistical procedure used. A total of 97 patterns composed of two or more diseases were identified. Among these, 63 patterns were composed of three or more diseases. Despite the methodological variability among studies, this review demonstrated relevant similarities for three groups of patterns. The first one comprised a combination of cardiovascular and metabolic diseases, the second one was related with mental health problems, and the third one with musculoskeletal disorders. CONCLUSION The existence of associations beyond chance among the different diseases that comprise these patterns should be considered with the aim of directing future lines of research that measure their intensity, clarify their nature, and highlight the possible causal underlying mechanisms.
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Affiliation(s)
- Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Pl +2, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Facultad de Medicina, C/ Domingo Miral s/n, 50009, Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Edificio CIBA, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain.
| | - Amaia Calderón-Larrañaga
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Pl +2, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Facultad de Medicina, C/ Domingo Miral s/n, 50009, Zaragoza, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Edificio CIBA, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Jorge Hancco-Saavedra
- Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Edificio CIBA, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Pl +2, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Edificio CIBA, Avda. San Juan Bosco 13, 50009, Zaragoza, Spain
| | - Marjan van den Akker
- CAPHRI School for Public Health and Primary Care, Maastricht University, P Debijeplein 1, PO Box 616, 6200 MD, Maastricht, The Netherlands; Department of General Practice, Katholieke Universiteit Leuven, Oude Markt 13 - box 5005, 3000, Leuven, Belgium
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Rada RE. Dental erosion due to GERD in patients with developmental disabilities: case theory. SPECIAL CARE IN DENTISTRY 2013; 34:7-11. [DOI: 10.1111/scd.12055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Robert E. Rada
- Clinical Associate Professor, Department of Oral Medicine and Diagnostic Sciences; University of Illinois College of Dentistry, Private Practice; LaGrange Illinois
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Holmqvist S, Santtila P, Lindström E, Sala E, Simberg S. The Association Between Possible Stress Markers and Vocal Symptoms. J Voice 2013; 27:787.e1-787.e10. [DOI: 10.1016/j.jvoice.2013.06.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 06/19/2013] [Indexed: 01/26/2023]
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Roth B, Bengtsson M, Ohlsson B. Diarrhoea is not the only symptom that needs to be treated in patients with microscopic colitis. Eur J Intern Med 2013; 24:573-8. [PMID: 23561634 DOI: 10.1016/j.ejim.2013.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/21/2013] [Accepted: 02/11/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Many patients with microscopic colitis (MC) also suffer from symptoms of irritable bowel syndrome (IBS), but the only treatment given is corticosteroids for the diarrhoea. The aim of this study was to examine how social factors, life style factors and drug treatment affect symptoms and well-being in patients suffering from MC. METHODS Women, over the age of 73years, with biopsy-verified MC, at any Departments of Gastroenterology, Skåne, between 2002 and 2010 were invited. The questionnaires Gastrointestinal Symptom Rating Scale (GSRS) and Psychological General Well-being Index (PGWB) were sent by mail, along with questions about social and life style factors, and medical history. RESULTS Of 240 invited, 158 patients (66%) were included (median age 63years, range 27-73years). Only 26% had never smoked. Smoking and concomitant IBS were associated with both impaired gastrointestinal symptoms (OR=3.96, 95% CI=1.47-10.66 and OR=4.40, 95% CI=2.09-9.26, respectively) and impaired psychological well-being (OR=2.77, 95% CI=1.04-7.34 and OR=3.82, 95% CI=1.83-7.99, respectively). Treatment with proton pump inhibitors (PPI) was associated with increased gastrointestinal symptoms (OR=3.44, 95% CI=1.45-8.16). Age, social factors, and corticosteroids had no effect on symptoms or well-being. Smoking was the only risk factor associated with IBS (OR=2.68, 95% CI=1.115-6.26). CONCLUSION Smoking and IBS are associated with impaired gastrointestinal symptoms and psychological well-being in MC patients. PPI is associated with impaired gastrointestinal symptoms.
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Affiliation(s)
- Bodil Roth
- Department of Clinical Sciences, Division of Gastroenterology, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
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Wang AJ, Wang H, Xu L, Lv NH, He XX, Hong JB, You Y, Zhu X. Predictors of clinical response of acid suppression in Chinese patients with gastroesophageal reflux disease. Dig Liver Dis 2013; 45:296-300. [PMID: 23333666 DOI: 10.1016/j.dld.2012.11.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/18/2012] [Accepted: 11/23/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Up to 40% of patients with gastroesophageal reflux disease fail to respond to proton pump inhibitor therapy. AIMS To determine predictors of clinical response of proton pump inhibitor therapy. METHODS Consecutive patients with gastroesophageal reflux disease were enrolled prospectively. All patients underwent upper endoscopy and 24-h multichannel intraluminal impedance and pH monitoring before receiving esomeprazole 20 mg b.i.d. for 2 months. Multivariate logistic regression analysis was used to determine the independent predictors of clinical response to proton pump inhibitor therapy. RESULTS A total of 204 patients with typical reflux symptoms were recruited and screened. Among them 153 patients (mean age 46.3 ± 10.6 years, 51.0% female) completed all the examinations and were assigned to proton pump inhibitor therapy. Ninety-five patients (62.1%) responded to acid suppression after 2 months. Multivariate logistic analysis showed that the predictor for response was pathological distal esophageal acid reflux (P = 0.001). The factors associated with proton pump inhibitor therapy failure were the presence of irritable bowel syndrome alone (P = 0.006), depression (P = 0.005), and overlap of irritable bowel syndrome and functional dyspepsia (P = 0.002). CONCLUSIONS The clinical response of acid suppression on gastroesophageal reflux disease could be predicted by clinical and pH parameters rather than impedance data.
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Affiliation(s)
- An Jiang Wang
- Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang, China.
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Chen T, Lu M, Wang X, Yang Y, Zhang J, Jin L, Ye W. Prevalence and risk factors of gastroesophageal reflux symptoms in a Chinese retiree cohort. BMC Gastroenterol 2012; 12:161. [PMID: 23153099 PMCID: PMC3573958 DOI: 10.1186/1471-230x-12-161] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 11/13/2012] [Indexed: 02/06/2023] Open
Abstract
Background Data about prevalence of gastroesophageal reflux diseases (GERD) from Asian populations are still scarce. To provide additional data on prevalence of GERD and investigate its potential risk factors, we performed this cross-sectional study in the Taizhou Retiree Cohort. Methods After physical examination, the participants were asked whether they suffered with heartburn or acid regurgitation in the last 12 months by trained interviewers, and if yes, the severity and frequency of the symptoms were recorded. Odds ratios (ORs) with 95% confidence intervals (CIs) for the associations of obesity and other risk factors with GERD were derived from logistic regression models. Results 8831 retirees completed the questionnaire and physical examination. In total 150 (1.7%) reported the symptoms occurring at least once per week within the last 12 months before the interview. Compared with subjects without GERD, having a history of diabetes mellitus (OR 2.2, 95% CI 1.4-3.5), hypertension (OR 1.4, 95% CI 1.0-2.1), gastritis (OR 8.2, 95% CI 5.8-11.5), peptic ulcer (OR 3.3, 95% CI 1.8-6.1) and high triglyceride level (≥1.81mmol/L) (OR 2.0, 95% CI 1.2-3.4) were associated with a significantly increased risk of GERD. However, there was no significant association between body mass index, waist-to-hip ratio or waist alone, smoking, consumption of alcohol & tea, and the occurrence of reflux symptoms. Conclusions Compared with Western populations, the prevalence of GERD in this Chinese retiree cohort is low. A history of diabetes mellitus, hypertension, gastritis, peptic ulcer or hypertriglyceridaemia increases GERD risk in this population.
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Affiliation(s)
- Tiantian Chen
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, 250012, China
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Fass R. Alternative therapeutic approaches to chronic proton pump inhibitor treatment. Clin Gastroenterol Hepatol 2012; 10:338-45; quiz e39-40. [PMID: 22178462 DOI: 10.1016/j.cgh.2011.12.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 02/07/2023]
Abstract
Chronic consumption of proton pump inhibitors (PPIs) by patients with gastroesophageal reflux disease is very common, primarily because of their potent and profound effect on acid secretion that results in an unsurpassed rate of symptom resolution and esophageal healing. However, there have been a growing number of reports over the past few years about various side effects caused by chronic PPI treatment. Concerns have been raised by patients and physicians alike about the common practice of prescribing PPIs, often more than once daily, on a long-term basis. As a result, there has been a resurgence of interest in alternative therapeutic modalities for chronic PPI treatment. These include novel endoscopic and surgical techniques, as well as other available therapeutic strategies that are likely to be revisited, such as histamine-2-receptor antagonists, intermittent and on-demand PPI treatment, and antireflux surgery, among others.
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Affiliation(s)
- Ronnie Fass
- The Neuroenteric Clinical Research Group, Southern Arizona VA Health Care System and University of Arizona Health Sciences Center, Tucson, Arizona 85723-0001, USA.
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Li J, Brackbill RM, Stellman SD, Farfel MR, Miller-Archie SA, Friedman S, Walker DJ, Thorpe LE, Cone J. Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City. Am J Gastroenterol 2011; 106:1933-41. [PMID: 21894225 DOI: 10.1038/ajg.2011.300] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Excess gastroesophageal reflux disease (GERD) was reported in several populations exposed to the September 11 2001 (9/11) terrorist attacks on the World Trade Center (WTC). We examined new onset gastroesophageal reflux symptoms (GERS) since 9/11 and persisting up to 5-6 years in relation to 9/11-related exposures among the WTC Health Registry enrollees, and potential associations with comorbid asthma and posttraumatic stress disorder (PTSD). METHODS This is a retrospective analysis of 37,118 adult enrollees (i.e., rescue/recovery workers, local residents, area workers, and passersby in lower Manhattan on 9/11) who reported no pre-9/11 GERS and who participated in two Registry surveys 2-3 and 5-6 years after 9/11. Post-9/11 GERS (new onset since 9/11) reported at first survey, and persistent GERS (post-9/11 GERS reported at both surveys) were analyzed using log-binomial regression. RESULTS Cumulative incidence was 20% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). Among enrollees with neither asthma nor PTSD, the adjusted risk ratio (aRR) for persistent GERS was elevated among: workers arriving at the WTC pile on 9/11 (aRR=1.6; 95% confidence interval (CI) 1.3-2.1) or working at the WTC site > 90 days (aRR=1.6; 1.4-2.0); residents exposed to the intense dust cloud on 9/11 (aRR=1.5; 1.0-2.3), or who did not evacuate their homes (aRR=1.7; 1.2-2.3); and area workers exposed to the intense dust cloud (aRR=1.5; 1.2-1.8). CONCLUSIONS Disaster-related environmental exposures may contribute to the development of GERS. GERS may be accentuated in the presence of asthma or PTSD.
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Affiliation(s)
- Jiehui Li
- New York City Department of Health and Mental Hygiene, New York, New York 11101, USA.
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Perlman SE, Friedman S, Galea S, Nair HP, Eros-Sarnyai M, Stellman SD, Hon J, Greene CM. Short-term and medium-term health effects of 9/11. Lancet 2011; 378:925-34. [PMID: 21890057 DOI: 10.1016/s0140-6736(11)60967-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The New York City terrorist attacks on Sept 11, 2001 (9/11), killed nearly 2800 people and thousands more had subsequent health problems. In this Review of health effects in the short and medium terms, strong evidence is provided for associations between experiencing or witnessing events related to 9/11 and post-traumatic stress disorder and respiratory illness, with a correlation between prolonged, intense exposure and increased overall illness and disability. Rescue and recovery workers, especially those who arrived early at the World Trade Center site or worked for longer periods, were more likely to develop respiratory illness than were other exposed groups. Risk factors for post-traumatic stress disorder included proximity to the site on 9/11, living or working in lower Manhattan, rescue or recovery work at the World Trade Center site, event-related loss of spouse, and low social support. Investigators note associations between 9/11 exposures and additional disorders, such as depression and substance use; however, for some health problems association with exposures related to 9/11 is unclear.
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Affiliation(s)
- Sharon E Perlman
- Division of Epidemiology, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA.
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Dellon ES, Shaheen NJ. Persistent reflux symptoms in the proton pump inhibitor era: the changing face of gastroesophageal reflux disease. Gastroenterology 2010; 139:7-13.e3. [PMID: 20493864 DOI: 10.1053/j.gastro.2010.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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