Title : Disorders of gut brain interaction in US veterans: A narrative review
Abstract:
There are around 19 million US Veterans alive today, which is about 7 percent of the US adult population. Veterans ranging from 18 to over 100 years of age have served and deployed around the world over the last century in support of a variety of combat and non-combat operations characterized by unique exposures that include infectious, environmental, and psychological stresses. Chronic gastrointestinal disorders are an important health concern in Veterans, and military- and Veteran-associated stressors are known to be important in our understanding of disorders of gut-brain interaction (DGBI) under the Rome IV framework, which were previously classified as functional gastrointestinal disorders (FGID). While many reviews have summarized current knowledge and research gaps on DGBI in the general adult, approaching these disorders uniquely focusing on the Veteran sub-population has not been described. To achieve this review, a comprehensive search using PubMed and DynaMed databases was performed using key words pertaining to the topic. We found a depth of research has described the epidemiology, mental health, and overlap with multi-symptom complex disorders among this population, but significant gaps in estimation of disease burden, pathogenesis, and effective treatment are present.
Audience Take Away:
- The prevalence of IBS was significantly increased in deployed Gulf War Veterans compared to their counterparts who were nondeployed and or deployed elsewhere
- The risk of gastrointestinal disorders was strongly associated with degree and number of mental health comorbidities.
- Environmental chemical exposures such as pyridostigmine bromide and permethrin may be associated with intestinal dysbiosis found in the affected population. It is helpful for physicians to recognize this association and be aware of the implications when providing care to veterans.
- Treatment approaches include GI-directed therapeutics, psychological intervention, and lifestyle modifications.
