Risk factors for IBS in military include stress, infectious gastroenteritis
New research confirms previous findings that stress and infectious gastroenteritis are associated with new-onset irritable bowel syndrome among members of the U.S. military.
“Previous studies have described IBS incidence and risk factors among the U.S. military members using the Department of Defense medical encounter databases, confirming other civilian population-based studies identifying gender and antecedent gastrointestinal infection as risk factors,” the researchers wrote. “However, these previous reports, which relied on existing administrative databases containing medical encounter and demographic data, lacked information on many confounders such as life stressors and health behaviors, which are likely important in understanding risk and underlying causal mechanisms for this condition.”
Researchers therefore aimed to further explore risk factors for new-onset IBS among 41,175 active duty military members enrolled in the Millenium Cohort Study, a large population-based cohort study of health impacts of military service initiated in 2001. All eligible participants for the current study did not have IBS or inflammatory bowel disease at baseline, completed a baseline survey and at least one follow-up survey by 2009, and remained on active duty at the time of their follow-up survey.
IBS was identified using medical encounter data, infectious gastroenteritis was identified using medical encounter data or self-report, and other covariates were identified using the surveys.
The researchers identified 314 new-onset cases of IBS (estimated incidence, 141.39 per 100,000 person-years), and risk factors included:
- antecedent infectious gastroenteritis (adjusted HR = 2.05; 95% CI, 1.53-2.75);
- female gender (aHR = 1.96; 95% CI, 1.53-2.52);
- army service (aHR = 0.67; 0.51-0.87);
- moderate alcohol consumptions (aHR = 0.68; 95% CI, 0.54-0.86);
- being overweight (aHR = 0.77; 95% CI, 0.61-0.99);
- obesity (aHR = 0.67; 95% CI, 0.46-0.97);
- one life stressor (aHR = 1.82; 95% CI, 1.37-2.41);
- two life stressors (aHR = 2.86; 95% CI, 2.01-4.06);
- three or more life stressors (aHR = 6.69; 95% CI, 4.59-9.77);
- anxiety syndrome (aHR = 1.74; 95% CI, 1.17-2.58);
- one deployment (aHR = 0.61; 95% CI, 0.47-0.8); and
- two or more deployments (aHR = 0.52; 95% CI, 0.39-0.7).
When the analysis was restricted to individuals with highly probably IBS, the association with antecedent infectious gastroenteritis was stronger (aHR = 2.2; 95% CI, 1.1-4.43), especially when based only on medical encounter records (aHR = 2.84; 95% CI, 1.33-6.09).
“Consistent interactions among highly probable IBS and [medical encounter only or all source infectious gastroenteritis] were found for both depression and anxiety,” the researchers wrote.
“In summary, these findings represent additional data that contribute to an accumulating body of evidence linking acute gastrointestinal infections and chronic gastrointestinal sequelae. In addition to important findings from mechanistic studies also being reported, our findings add to the belief that this observed phenomenon is not exaggerated.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.