Risk factors for upper and lower functional gastrointestinal disorders in Persian Gulf War Veterans during and post-deployment

Tuteja AK1,2, Talley NJ3, Stoddard GJ4, Samore MH1, Verne GN5,6. Neurogastroenterol Motil. 2019 Jan 29:e13533. doi: 10.1111/nmo.13533. [Epub ahead of print]


Author information

George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah.

Division of Gastroenterology, University of Utah, Salt Lake City, Utah.

University of Newcastle, Callaghan, New South Wales, Australia.

Division of Epidemiology, University of Utah, Salt Lake City, Utah.

Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana.

North Florida/South Georgia Veterans Affairs Medical Center, Gainesville, Florida.


BACKGROUND: Gastroenteritis is a risk factor for irritable bowel syndrome (IBS), but its role in other functional gastrointestinal disorders (FGIDs) is less clear. The aim of this study was to determine the prevalence of FGIDs in Gulf War (GW) Veterans before, during, and after deployment and to determine whether gastroenteritis was a risk factor for upper and lower FGIDs.

METHODS: The Veterans who served during the Persian GW were mailed validated questionnaires inquiring about their bowelhabits, psychological and extra-intestinal symptoms, and quality of life (QOL). The lactulose hydrogen breath test (LBT) was performed for small intestinal bacterial overgrowth.

KEY RESULTS: Data were analyzed from 468 GW Veterans. The prevalence of FGID before, during, and 16 years after deployment was 15.7%, 49.9%, and 64.2%, respectively. New FGIDs during deployment was reported by 41.2%, and during 16 years after deployment, 43.7% acquired new FGIDs. FGIDs were associated with psychological disorders, extra-intestinal symptoms, and lower QOL. Gastroenteritis was reported by 44.3% of deployed Veterans and was a risk factor for IBS, dyspepsia, and functional diarrhea post-deployment. The cases and controls did not differ significantly in the frequency of positive LBT.

CONCLUSIONS AND INFERENCES: There is an increase in the prevalence of FGIDs during deployment, and it persists after deployment. There is a further increase in the prevalence of FGIDs after deployment. In addition to IBS, gastroenteritis during deployment is a risk factor for dyspepsia and functional diarrhea post-deployment. Therefore, prevention of gastroenteritis during deployment and screening of Veterans for FGIDs post-deployment would be of value for Veterans' long-term health.

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