Heartburn, Reflux Seen in 9/11 Survivors

New Study Shows Lingering Health Effects of People at Ground Zero

Medically Reviewed by Laura J. Martin, MD on September 07, 2011
From the WebMD Archives

Sept. 7, 2011 -- Many people who were exposed to the dust cloud after the terror attacks on Sept. 11, 2001, may have developed lasting heartburn, indigestion, acid reflux, and other symptoms of gastroesophageal reflux disease (GERD).

The new findings appear in the American Journal of Gastroenterology. They bolster the results of another recent study that looked at the lingering health effects, including heartburn and acid reflux, seen among rescue and recovery workers at Ground Zero.

“This study provides more evidence to support that there could be a relationship between 9/11 exposure and GERD symptoms,” says researcher Jiehui Li, MBBS. She is with the New York City Department of Health and Mental Hygiene in Long Island City, N.Y.

The study looked at symptoms of GERD, not GERD itself.

GERD symptoms may include:

Researchers surveyed more than 37,000 adults who lived or worked near Ground Zero who did not report any GERD symptoms prior to 9/11. Of these, 20% had some new GERD symptoms after 9/11. For 13%, these symptoms persisted for at least five to six years, the study showed.

The findings held even among people who did not have asthma or posttraumatic stress disorder (PTSD). Both of these conditions have been found to coexist with GERD.

The researchers speculate that alkaline cement -- one of the components seen in the dust cloud that enveloped lower Manhattan after the terror attacks - may have contributed to causing asthma and GERD.

GERD-Cancer-9/11 Question?

Persistent GERD is a risk factor for a precancerous condition known as Barrett’s esophagus. This condition is marked by abnormal changes in the cells that line the esophagus.

It’s too early to say whether people who developed GERD symptoms from exposure to the dust at Ground Zero are at a higher risk for developing esophageal cancer.

“This is unknown territory because we haven’t experienced exposures like this before,” says researcher Steven D. Stellman, PhD, MPH. He is also with the NYC Department of Health.

“As time goes on and as we continue to survey these individuals, we will discover if these symptoms persist,” he says.

American Journal of Gastroenterology Co-Editor in Chief William Chey, MD, says the new paper sheds light on the 9/11-GERD connection. He is a professor of medicine at the University of Michigan Health System in Ann Arbor.

“By no means does this study suggest that there is an increased risk of cancer,” he says.

“The individuals involved with 9/11 had a significantly increased risk of developing GERD symptoms,” he says. “A lot of us would have assumed that it was related to PTSD and asthma, but 9/11 was an independent risk factor for these symptoms.”

Something in or about the dust may have irritated the esophagus or made it more sensitive to acid, he says. “If you are having frequent heartburn or regurgitation that occurs more than three times per week, particularly at night that interferes with your sleep, or difficulty swallowing, see a doctor,” he says.

“Frequent severe heartburn can be a sign of something more sinister, and there are very effective therapies for these symptoms,” he says.

Dust Inhaled and Swallowed

The new findings are “not unexpected,” says E. Neil Schachter, MD, the medical director of respiratory care at Mount Sinai Medical Center in New York.

The asthma-GERD connection is a well-known one, he says.

There are some safety mechanisms in place that prevent what we eat or drink from entering our lungs (aspiration), he says.

After 9/11, “all that stuff that was breathed into the back of our throats got mixed in with saliva and we swallowed it,” he says.

This may have irritated the upper GI tract and caused some of the symptoms seen in the new study, he says.

Show Sources


Jiehui Li, MBBS, New York City Department of Health and Mental Hygiene, Long Island City, N.Y.

Li, J. American Journal of Gastroenterology, published online Sept. 6, 2011.

Steven D. Stellman, PhD, MPH, New York City Department of Health and Mental Hygiene, Long Island City, N.Y.

E. Neil Schachter, MD, medical director, respiratory care, Mount Sinai Medical Center, New York City.

William Chey, MD, professor of medicine, University of Michigan Health System, Ann Arbor.

Wisnivesky, J. Lancet, 2011: vol 378: pp 888-897.

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