Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

D Malhotra; S H Boyle; E J Gifford; B A Sullivan; T H Nguyen Wenker; Nono-Djotsa Abs; S T Ahmed; J Upchurch; J Vahey; C Stafford; J T Efird; S C Hunt; A Bradford; K J Sims; E R Hauser; D A Helmer; C D Williams

doi:10.1111/nmo.14548

Self-reported gastrointestinal disorders among veterans with gulf war illness with and without posttraumatic stress disorder

Neurogastroenterol Motil. 2023 May;35(5):e14548. doi: 10.1111/nmo.14548. Epub 2023 Mar 21.

Authors

D Malhotra^{1

2}, S H Boyle², E J Gifford^{2

3}, B A Sullivan^{1

2}, T H Nguyen Wenker^{4

5}, Nono-Djotsa Abs^{4

5

6}, S T Ahmed^{4

5}, J Upchurch², J Vahey^{2

7}, C Stafford², J T Efird^{8

9}, S C Hunt^{10

11}, A Bradford⁴, K J Sims², E R Hauser^{2

12}, D A Helmer^{4

5}, C D Williams²

Affiliations

¹ Duke University School of Medicine, Durham, North Carolina, USA.
² Cooperative Studies Program Epidemiology Center, Durham VA Medical Center, Durham VA Health Care System, Durham, North Carolina, USA.
³ Center for Child and Family Policy, Duke Margolis Center for Health Policy, Duke University Sanford School of Public Policy, Durham, North Carolina, USA.
⁴ Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
⁵ VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (IQuEST), Michael E. DeBakey VA Medical Center, Houston, Texas, USA.
⁶ Big Data Scientist Training Enhancement Program (BD-STEP), VA Office of Research and Development, Washington, DC, Washington, USA.
⁷ Computational Biology and Bioinformatics Program, Duke University School of Medicine, Durham, North Carolina, USA.
⁸ VA Cooperative Studies Program Coordinating Center, Boston, Massachusetts, USA.
⁹ Department of Radiation Oncology, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁰ VA Puget Sound Health Care System, Seattle, Washington, USA.
¹¹ Department of Medicine, University of Washington, Seattle, Washington, USA.
¹² Department of Biostatistics and Bioinformatics, Duke University Medical Center, Duke Molecular Physiology Institute, Durham, North Carolina, USA.

PMID: 36942766
DOI: 10.1111/nmo.14548

Abstract

Background: Gulf War Illness (GWI) is a chronic, multi-symptom disorder affecting 25%-32% of Gulf War veterans. Veterans with GWI disproportionately suffer from gastrointestinal (GI) disorders. Given the increasing evidence supporting a gut-brain axis, we explore the relationship between post-traumatic stress disorder (PTSD), GWI, and self-reported GI disorders among GW veterans.

Methods: Veterans from the Gulf War Era Cohort and Biorepository responded to a mail-based survey (N = 1058). They were stratified by GWI (Centers for Disease Control definition) and PTSD status. This yielded three groups: GWI-, GWI+/PTSD-, and GWI+/PTSD+. Multivariable logistic regression adjusting for demographic and military characteristics examined associations between GWI/PTSD groups and GI disorders. Results were expressed as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI).

Key results: The most frequently reported GI disorders were irritable bowel syndrome (IBS), gastroesophageal reflux disease (GERD), and colon polyps (CP). The GWI+/PTSD+ group had a higher odds of these disorders than the GWI+/PTSD- group (aOR_IBS = 3.12, 95% CI: 1.93-5.05; aOR_GERD = 2.04, 95% CI: 1.44-2.90; aOR_CP = 1.85, 95% CI: 1.23-2.80), which had a higher odds of these disorders than the GWI- group (aOR_IBS = 4.38, 95% CI: 1.55-12.36; aOR_GERD = 2.51 95% CI: 1.63-3.87; aOR_CP = 2.57, 95% CI: 1.53-4.32).

Conclusions & inferences: GW veterans with GWI and PTSD have significantly higher odds of specific self-reported GI disorders than the other groups. Given the known bidirectional influences of the gut and brain, these veterans may benefit from a holistic healthcare approach that considers biopsychosocial contributors to the assessment and management of disease.

Keywords: Persian gulf syndrome; biopsychosocial models; brain-gut Axis; colonic polyps; gastroesophageal reflux; irritable bowel syndrome; post-traumatic stress disorders.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Gastroesophageal Reflux*
Gastrointestinal Diseases*
Gulf War
Humans
Irritable Bowel Syndrome*
Persian Gulf Syndrome*
Self Report
Stress Disorders, Post-Traumatic*
Veterans* / psychology

Grants and funding

T32 GM071340/GM/NIGMS NIH HHS/United States