1104. Deployment-Associated Infectious Gastroenteritis and Associations with Irritable Bowel Syndrome, Post-Traumatic Stress Disorder, and Combat Stress: A Retrospective Cohort Study Among Deployed United States Military Personnel
Session: Poster Abstract Session: Enteric Infections
Friday, October 5, 2018
Room: S Poster Hall

Previous studies have shown an association between post-traumatic stress disorder (PTSD) and the development of irritable bowel syndrome (IBS) in deployed service members. Deployment places soldiers at risk for chemical, physical, psychological, and infectious stressors. Acute stress can alter the gastrointestinal barrier leading to gut barrier dysfunction, which is an independent risk factor for infectious gastroenteritis (IGE). We sought to assess if there was an association between IBS and PTSD in military deployed in support of recent and ongoing military operations.


We conducted a retrospective cohort study of United States service members who participated in a combat deployment to the Middle East from 2001-2013 with no prior Axis I disorders or PTSD diagnoses based on data from the Defense Medical Surveillance System. Univariate and multivariate logistic regression models were used to assess the differential risk of PTSD following a combat deployment among those with and without a pre-deployment diagnosis of IBS. These models were controlled for confounders/covariates of interest (IGE, age, duration of deployment, sex, race, marital status, education level, military rank, branch of service, number of deployments).


Among the 3825 subjects, those who developed IGE had a 34% (p=0.02) increased risk of PTSD compared to those with no IGE during deployment. Additionally, those with IBS pre-deployment had a 40% (p=0.001) increased risk of PTSD upon return from deployment compared to those without IBS pre-deployment. Duration of deployment was significantly (p<0.0001) associated with PTSD with an increasing risk with increasing duration of deployment.


IGE and IBS were significantly associated with PTSD further supporting previous studies describing their association. Baseline chronic dysbiosis and acute stress-related microbiota perturbations may lead to short and long-term resilience and performance deficits in our soldiers that may compromise mission capabilities and decrease the quality of life in returning soldiers. Further understanding the potential interactions between the gut-brain-microbiome may have immediate and long-term impacts on improving warfighter health and performance.

Christopher R. Dunbar, DO1, Mark S. Riddle, MD, DrPH2, Kristen Clarkson, PhDc3, Ramiro L. Gutierrez, MD, MPH4, Ashley Alcala, BSPH4, Angelique Byrd, MPH5 and Chad K. Porter, PhD, MPH4, (1)Walter Reed National Military Medical Center, Bethesda, MD, (2)Uniformed Services University of Health Sciences, Bethesda, MD, (3)Walter Reed Army Institute of Research, Silver Spring, MD, (4)Enteric Diseases Department, Naval Medical Research Center, Silver Spring, MD, (5)Naval Medical Research Center, Silver Spring, MD


C. R. Dunbar, None

M. S. Riddle, None

K. Clarkson, None

R. L. Gutierrez, None

A. Alcala, None

A. Byrd, None

C. K. Porter, None

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