Job Stress Brings Gastrointestinal Problems

Study Shows High Levels of Gut Problems Among Military and 9/11 Cleanup Crews

Medically Reviewed by Louise Chang, MD on October 27, 2009
From the WebMD Archives

Oct. 27, 2009 -- Stress can be hard on your gut. And that may be especially true when the work environment is extraordinarily stressful -- such as cleaning up after the 9/11 attacks or serving in the military, according to researchers who have found a link between these stressful jobs and gastrointestinal problems.

The studies were presented this week at the annual meeting of the American College of Gastroenterology in San Diego.

Workers who helped with the cleanup at the World Trade Center after the 9/11 attacks are more likely than the general population to get GERD (gastroesopheal reflux disease), in which contents of the stomach travel back up to the esophagus, says Yvette Lam, MD, a gastroenterologist at Stony Brook University Medical Center, N.Y., who presented the results of a study at the meeting.

She also found an association between GERD and mental health disorders.

With her colleagues, she evaluated 697 patients, ages 34 to 50, who helped with the cleanup. At the first visit, conducted between October 2005 and September 2006, 41% had GERD, compared with about 20% of the general population.

The researchers also found those with GERD were more likely to have mental health disorders such as depression or anxiety. At the first visit, 21% of those with GERD had posttraumatic stress disorder (PTSD), 21.5% had depression, and nearly 30% had anxiety disorder.

In all, 413 patients came for the second visit conducted about two years later, to see if the problems persisted. At visit two, the mental health problems persisted, with 21.3% of those who had GERD at the first visit reporting PTSD and 32.8% reporting depression.

''The GERD prevalence also rose with an increasing number of mental health disorders," Lam says. Obesity, considered a risk factor for GERD, wasn't linked with it in this study. But exposure to such things as dealing with human remains was associated with both the GERD and the PTSD, she says.

Treatment of the mental health disorders may be crucial to resolving the GERD, Lam says.

Gastrointestinal Problems in the Military

Gastrointestinal problems are also prevalent in military personnel, says Mark Riddle, MD, DrPH, a researcher at the Naval Medical Research Center in Silver Spring, Md. Servicemen and servicewomen, he says, "are under a lot of stress as you can imagine during deployment."

Riddle says the fourth leading cause of visits to VA Medical Centers is gastrointestinal disorders.

To find out more, Riddle and his colleagues evaluated data from the Defense Medical Surveillance System, identifying nearly 32,000 cases of gastrointestinal problems in active duty U.S. military personnel between 1999 and 2007. Among the problems were constipation, diarrhea, irritable bowel syndrome (IBS), and indigestion after an infection of the stomach and intestines (gastroenteritis).

When Riddle looked for links between the past gastrointestinal problems and current ones, he found an association between a history of gastroenteritis -- infection of the stomach and intestines caused by bacteria, virus, or other organisms -- and all types of gastrointestinal problems later.

The highest risk was for diarrhea and IBS. Having a history of gastroenteritis boosted the risk of diarrhea sixfold, and of IBS nearly fourfold. The increased risk for constipation or indigestion was less, each about twofold.

The gastrointestinal problems persist, Riddle found. Nearly 30% of the military with problems were still getting care two years after the diagnosis.

The typical advice to prevent gastrointestinal infections -- such as boiling water or peeling food that may be contaminated -- doesn't hold up in combat situations or emergency environments such as the post 9/11 cleanup, Riddle says.

''We are developing vaccines to hopefully prevent [gastrointestinal infections]," he says.

"We need to come up I think with a vaccine -- a good solution -- or chemoprophylaxis like you take for malaria. But it would have to be something you could safely take for a long time."

Show Sources


American College of Gastroenterology annual meeting, San Diego, Oct. 23-27, 2009.

Yvette Lam, MD, gastroenterologist, Stony Brook University Medical Center, N.Y.

Mark Riddle, MD, DrPH, Naval Medical Research Center, Silver Spring, Md.

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