"When we deploy overseas, one of the biggest risks is infectious gastrointestinal disorders."

NEWS from Larry Scott, VA Watchdog dot Org

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ACG: GIs With GI Infections Likely to Suffer Long-Term Bowel Problems

By Kristina Fiore, Staff Writer, MedPage Today

Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

http://www.medpagetoday.com/MeetingCoverage/ACG/16668

SAN DIEGO -- Troops who suffered a bout of infectious gastroenteritis while serving -- as in dysentery or diarrhea -- are more likely than others to suffer longer-term bowel disorders, researchers said here.

These servicemen and women were about six times more likely to develop subsequent functional diarrhea, and about four times as likely to have irritable bowel syndrome later on, Mark Riddle, MD, of the Naval Medical Research Center in Silver Spring, Md., and colleagues reported at the American College of Gastroenterology meeting here.

"Post-traumatic stress disorder and traumatic brain injury are common postdeployment disorders," Riddle said, "but functional bowel problems are a significant burden as well."

He said that among the top reasons for visits to Veterans Affairs hospitals, gastrointestinal disorders rank fourth, and 30% of forces get diarrhea each month as a result of bacteria they're exposed to.

"When we deploy overseas, one of the biggest risks is infectious gastrointestinal disorders," Riddle said. "By six months, troops will usually have one or more episodes of infectious gastroenteritis."

Through this research, Riddle says physicians are "beginning to realize that it's not just about the acute episodes. It's the [long-term effects] that are an important burden of disease ... and need to be considered in moving forward with strategies to prevent these illnesses."

Col. Roy K.H. Wong, MD, chief of gastroenterology at Walter Reed Army Medical Center in Washington, said the findings highlight "a better understanding of the pathophysiology" of these infections and later diseases.

"It's very interesting, because it really does have long-term effects on deployment," Wong said. Patients who suffer from long-term gastrointestinal disorders who are redeployed, for example, may trigger worsening disease if they're involved in stressful situations.

For their study, the researchers assessed 31,866 cases of functional gastrointestinal disorders, including irritable bowel syndrome, functional constipation, functional diarrhea, and dyspepsia in active duty personnel between 1999 and 2007.

These patients had had two or more visits to the clinic for their symptoms.

Each case was matched with four controls, and the researchers looked for a history of an infectious gastroenteritis episode.

They found a significant association between infection and subsequent functional bowel disorders.

Patients were at a 6.26-fold increased risk of irritable bowel syndrome and a 3.72-fold increased risk of functional diarrhea if they'd had a previous infection, the researchers said.

Patients also had an increased risk of functional constipation and dyspepsia (OR 2.15 and OR 2.39, respectively).

The researchers also assessed whether the cause of the infection had an impact on subsequent disease.

If it were attributable to Campylobacter, Shigella, or Salmonella, patients were at a significantly increased risk of irritable bowel syndrome (OR 5.50, 95% CI 2.21 to 13.67, P<0.001) and dyspepsia (OR 5.00, 95% CI 1.34 to 18.62, P=0.02).

They were not, however, at a significantly increased risk for functional constipation or diarrhea.

Riddle said the mechanisms of the association remain unknown, although it may be related to changes in gut microbiota or neural symptoms related to the gastrointestinal tract.

Cdr. Brooks Cash, MD, of the National Naval Medical Center, said "the $10,000-question is why these disorders come up after infectious gastroenteritis."

"This kind of work will shed some light on that," Cash added.

The researchers also found that continued treatment for symptoms of the long-term bowel disorders fell after the first year but then plateaued -- a trend similar to other common problems familiar to personnel, including reactive arthritis and Guillain Barre syndrome.

That puts a large burden on the healthcare system that could be prevented, Riddle said.

The findings may also translate to the population at large.

"We need to think about how these infections affect long-term health of not only the military and travelers, but [the general population] as well, particularly if you think about the vast majority of food-borne illness in the U.S.," Riddle said. "There's a considerable understanding to gain, and we need to think about the impact of these chronic sequelae, not just acute disease."

The researchers reported no conflicts of interest.

Primary source: American College of Gastroenterology

Source reference:
Riddle M, et al "Post-infectious functional gastrointestinal disorders in the U.S. Military" ACG 2009; Abstract 1.

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TOPICS: veterans, veterans' benefits, VA, Department of Veterans' Affairs, gastrointestinal, disorders, infections