Irritable Bowel Syndrome in Veterans With Gulf War Illness Evaluated at VA's War-Related Illness and Injury Study Center.

IF 1.2 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Military Medicine Pub Date : 2024-11-05 DOI:10.1093/milmed/usae260
Alice B S Nono Djotsa, Theresa H Nguyen Wenker, Sarah T Ahmed, Saurendro Ghosh, Deeksha Malhotra, Stephen H Boyle, Elizabeth J Gifford, Kellie J Sims, Donna L White, Lea Steele, Drew A Helmer
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Abstract

Introduction: Excess rates of Gulf War illness (GWI) and irritable bowel syndrome (IBS), two chronic multisymptom illnesses, have long been documented among nearly 700,000 veterans who served in the 1990-1991 Persian Gulf War. We sought to report the prevalence, characteristics, and association of GWI and IBS decades after the war in a clinical cohort of deployed Gulf War veterans (GWVs) who were evaluated at the Department of Veterans Affairs' War Related Illness and Injury Study Center (WRIISC) for unexplained chronic symptoms.

Materials and methods: We analyzed data gathered from clinical intake questionnaires of deployed GWVs who were evaluated at WRIISC clinics between 2008 and 2020. We applied Centers for Disease Control (CDC) criteria to determine the prevalence of severe GWI. IBS was identified using Rome IV diagnostic criteria (current IBS) and veterans' self-reported "history of physician-diagnosed IBS." We examined associations between IBS and GWI using bivariate analyses and multivariable logistic regression.

Results: Among the N = 578 GWVs evaluated by the WRIISC, severe GWI (71.8%), history of physician-diagnosed IBS (50.3%) and current IBS (42.2%) were all highly prevalent. Nearly half of GWVs with severe GWI met Rome criteria for IBS (45.8%), and over half reported a history of physician-diagnosed IBS (56.1%). In multivariable models, severe GWI was significantly associated both with current IBS (adjusted odds ratio (aOR): 1.68, 95% CI: 1.11, 2.54) and with veteran-reported history of physician-diagnosed IBS (aOR: 2.15, 95% CI: 1.43, 2.23). IBS with diarrhea (IBS-D) was the most common subtype among GWVs with current IBS (61.1%). However, IBS-mixed affected a significantly greater proportion of veterans with severe GWI, compared to veterans who did not have severe GWI (P = .03).

Conclusions: More than 20 years after the Persian Gulf War, our findings indicate a high degree of comorbidity between severe GWI and IBS among deployed GWVs seeking care for unexplained illnesses. Our results suggest GWVs with GWI should be screened for IBS for which evidence-based treatments are available and could potentially reduce symptom burden. Conversely, symptoms of IBS should trigger additional evaluation for non-gastrointestinal symptoms in deployed Gulf War veterans to identify possible GWI and ensure a comprehensive approach to care.

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退伍军人事务部战争相关疾病和伤害研究中心对患有海湾战争疾病的退伍军人进行肠易激综合征评估。
导言:在 1990-1991 年波斯湾战争中服役的近 70 万名退伍军人中,海湾战争病(GWI)和肠易激综合征(IBS)这两种慢性多症状疾病的发病率一直居高不下。我们试图报告战后数十年,在退伍军人事务部战争相关疾病和伤害研究中心(WRIISC)接受不明原因慢性症状评估的海湾战争退伍军人(GWVs)临床队列中,GWI 和 IBS 的患病率、特征和关联性:我们分析了 2008 年至 2020 年期间在 WRIISC 诊所接受评估的已部署退伍军人的临床入院问卷调查数据。我们采用美国疾病控制中心 (CDC) 的标准来确定严重 GWI 的患病率。肠易激综合征是根据罗马 IV 诊断标准(当前肠易激综合征)和退伍军人自我报告的 "医生诊断肠易激综合征病史 "确定的。我们通过双变量分析和多变量逻辑回归研究了肠易激综合征与 GWI 之间的关系:结果:在接受 WRIISC 评估的 N = 578 名 GWV 中,严重 GWI(71.8%)、医生诊断的肠易激综合征病史(50.3%)和当前肠易激综合征(42.2%)的发病率都很高。近一半有严重 GWI 的 GWV 符合罗马肠易激综合征标准(45.8%),超过一半的 GWV 报告有医生诊断的肠易激综合征病史(56.1%)。在多变量模型中,严重 GWI 与当前肠易激综合征(调整赔率 (aOR):1.68,95% CI:1.11, 2.54)和退伍军人报告的医生诊断肠易激综合征病史(aOR:2.15,95% CI:1.43, 2.23)均有显著相关性。在目前患有肠易激综合征的退伍军人中,肠易激综合征伴腹泻(IBS-D)是最常见的亚型(61.1%)。然而,与没有严重GWI的退伍军人相比,患有严重GWI的退伍军人中患混合型肠易激综合征的比例明显更高(P = .03):结论:在波斯湾战争结束 20 多年后,我们的研究结果表明,在因不明原因疾病就医的已部署 GWV 中,严重 GWI 和肠易激综合征的合并率很高。我们的研究结果表明,有 GWI 的 GWV 应接受肠易激综合征筛查,目前已有循证治疗方法,有可能减轻症状负担。相反,肠易激综合征的症状应引发对已部署的海湾战争退伍军人非胃肠道症状的额外评估,以识别可能的 GWI 并确保采取全面的护理方法。
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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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