Associations between irritable bowel syndrome and post traumatic stress disorder among veteran populations

• Main Author: Arokiadoss, Abishek
• Other Authors: Garcia-Diaz, Jesus Fernando
• Language: en_US
• Published: 2021
• Subjects: Medicine
• Online Access: https://hdl.handle.net/2144/43320

BACKGROUND: Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder (FGID) characterized by recurrent abdominal pain and change in bowel habits and is highly associated with depression and anxiety. IBS is estimated to affect about 5-20% of the global population2,29. However, little data exist regarding the association of IBS in patients with Post Traumatic Stress Disorder (PTSD). Therefore, we investigated the Veterans’ After-discharge Longitudinal Registry (VALOR) cohort of combat-exposed veterans with and without PTSD for comorbid IBS, functional dyspepsia (FD), and Gastroesophageal Reflux Disease (GERD). METHODS: Medical records of veterans enrolled in the VALOR project (N=1649) with (N=1028) and without PTSD (N=619) were examined for the presence of IBS, FD, and GERD based on ICD coding at time points T1 (baseline) and T4 (average follow up 4.7 years). Male and female veterans were recruited into the study at a ratio of 1:1. IBS diagnosis was made using ICD 9/10 coding and PTSD diagnosis was made using the PTSD module of the Structured Clinical Interview for DSM-IV. Statistical analyses of data were performed using Chi-square test, T-test, and logistic regression analyses. RESULTS: Baseline demographics of veterans with PTSD and control subjects were similar. IBS and FD were present in VALOR subjects with (3.9%, 1.2%, respectively) and without PTSD (3.4%, 0.8%) in similar frequencies (p=0.6 and p=0.48, respectively) at baseline whereas GERD without esophagitis is significantly more frequent in the PTSD group relative to the No PTSD group (14.8%, 10.3%, respectively; p=0.01). Over the course of the study the diagnosis of IBS, and other related FGID, decreased from T1 to T4. The only diagnosis that did change significantly was an increase in GERD with esophagitis. At T1, the only diagnosis that was more common in veterans with PTSD compared to veterans without PTSD was GERD without esophagitis. At both T1 and T4 the severity of PTSD did not predict a diagnosis of most FGID including IBS, GERD with esophagitis, or functional dyspepsia. However, rates of GERD without esophagitis were positively correlated with severity of PTSD symptoms. At T1 veterans with re-experiencing symptoms of PTSD were more likely to have IBS. However, at T4 veterans with avoidance symptoms of PTSD were more likely to have IBS, while veterans with re-experiencing symptoms, negative changes in mood of cognition, and those experiencing hyperarousal were more likely to have GERD without esophagitis. CONCLUSIONS: Prior studies have shown that combat-exposed veterans were at risk for IBS, however we report PTSD in combat-exposed veterans did not incur a risk for the association with IBS or FD but did so for GERD, specifically PTSD in combat exposed veterans did incur a risk for the association GERD without esophagitis and was positively correlated to the severity of PTSD symptoms. Specific subgroups of PTSD symptoms were also found to correlate with specific diagnoses. Specifically, the re-experiencing symptom subtype of PTSD was associated with a higher rate of IBS.