Gastroesophageal Reflux Disease in the World Trade Center Health Program General Responder Cohort

Abstract

Background

People participating in the rescue, recovery, and clean-up effort after the September 11, 2001 attack on the World Trade Center (WTC) were exposed to a complex mix of noxious substances and subsequently experienced elevated gastroesophageal reflux disease (GERD) incidence, the second-most-common WTC-related condition.

Methods

Longitudinal WTC Health Program data, collected between July 2002 and December 2022, were used to describe the sample characteristics, diagnostic procedures, and treatment of consenting cohort members with self-reported GERD who reported incident GERD for a year or longer (n = 19,067). Cross-tabulations and binomial logistic regression, adjusted for confounders including comorbidities, assessed the associations with intermittent and resolved, compared with unresolved, GERD.

Results

12.6% of the study cohort reported intermittent GERD; 5.5% reported GERD resolution. Analyses indicated that most GERD resolution was reported by people of color and those with body mass index <25, and by cohort members who had longer postdiagnosis follow-up and implemented dietary modifications together with proton pump inhibitors or Program-approved antacids. GERD-certified members who underwent endoscopy, used medications without dietary modifications, or used bed head-elevation, and those with Barrett's disease (5.8%) or esophageal cancer (0.1%) may have had more severe GERD and reported little resolution.

Conclusions

The use of GERD services was consistent with clinical guidelines. Members' implementing dietary modifications in conjunction with proton pump inhibitors or Program-approved antacids reported more resolution and may have had less severe GERD. Earlier diagnosis and intervention might increase earlier therapeutic resolution.