Among the 50,000+ individuals who participated in a government-sponsored registry, symptoms relating to gastrointestinal upset (discomfort, bloating, diarrhea, etc.) did not rank in the top 10 symptoms.

Of these 50,000+ individuals, approximately 10,000 (20%) were described as having unexplained signs and symptoms and other ill-defined conditions. Four percent (4%) of this group reported gastrointestinal upset/diarrhea-like symptoms.

A study including almost 4000 Service Members compared symptoms of those people who deployed to the Persian Gulf War theater of operations to a similar group of people who were not deployed.

• 25% of those deployed reported gas, bloating, cramps and stomach pain that lasted for longer than 6 months. Approximately one-half this amount (11%) of the non-deployed personnel reported similar symptoms lasting longer than 6 months.
  
  
• 16% of those deployed reported diarrhea that lasted for longer than 6 months. 1% of the non-deployed personnel reported diarrhea lasting longer than 6 months.
  

In this study of 4000 Service Members stool samples were checked for germs, parasites and infections that might cause things like discomfort, diarrhea and gas.

While many veterans of Operation Desert Storm reported stomach upset (including diarrhea, bloating and discomfort), the stool samples that were checked did not show anything that might be the cause of these particular symptoms.

This means that the chance of having an illness specific to something unique from the Persian Gulf is small. These types of symptoms occur often in the general population and are described by doctors as "functional bowel disorders."

When a person complains of non-specific gastrointestinal upset (abdominal or stomach pain/discomfort, bloating, diarrhea, constipation, etc.) this might suggest a functional bowel disorder. Functional bowel disorders typically do not occur as a result of structural abnormality or infection.

To meet precise diagnostic criteria (these are usually for research purposes and are not necessary for clinical use) for a functional bowel disorder, symptoms must occur for at least 12 weeks (it does not have to be in a row) over the previous 12 months.

Some examples include:

1. Irritable bowel syndrome (affects ~15-20% of the population)
   
   • Described by patients as abdominal pain or discomfort that is related to bowel movements or a change in bowel movement habit (change in how often, change in form-alternating between diarrhea-like and constipation, straining, feelings of not having finished, bloating)
     
   • Symptoms can come and go
     
     
2. Functional abdominal bloating (affects ~15 of the population)
   
• Feeling of abdominal fullness or bloating is the most apparent symptom
  
• Usually this feeling is absent or less upon getting up in the morning and appears or gets worse as the day goes on
  
  
3. Functional constipation (affects ~20 of the population)
   
   • Described by patients as "persistent difficult, infrequent, or seemingly incomplete" bowel movements
     
   • Increasing fiber in the diet is often a good way to manage constipation
     
     • Adding fiber increases the amount of indigestible materials and encourages water uptake to the fecal matter
       
       
4. Functional diarrhea
   
   • Described by patients as very frequent or recurrent bowel movements that loose, mushy, and/or watery
     
   • Generally not associated with discomfort
     
   • Spontaneous resolution of symptoms is common
     
     
5. Functional abdominal pain syndrome (affects ~2% of the population)
   
   • Described by patients as constant or nearly constant abdominal pain that does not seem to be related to things like eating or bowel movements
     
   • The pain has generally been present for at least 6 months
     
   • The pain interferes with daily living
     

As with many things, the gut can be affected by stress and emotions. Often people who report a high-stress lifestyle are more likely to develop these types of disorders than people who do not report a high-stress life

A high-stress lifestyle and/or psychological factors in and of themselves are not likely causes of functional bowel disorders, but each of these can make symptoms worse or keep them from getting better.

Interestingly, some patients report that their symptoms started after a particular event. One theory is that a one-time, short-lived infection (for example, traveler’s diarrhea) may "prime" the gut for continued symptoms

• Approximately 10-25% of patients with irritable bowel syndrome report that their symptoms followed an illness or a bout of traveler’s diarrhea
  

What are the treatment options for functional bowel disorders?

References

1. Gray, G. C., Reed, R. J., Kaiser, K. S., Smith, T. C., and Gastanaga, V. M. Self-Reported Symptoms and Medical Conditions Among 11,868 Gulf War-Era Veterans: The SeaBee Study. Am J Epidemiol 2002;155(11):1033-44.

2. Fukuda, K., Nisenbaum, R., Stewart, G., Thompson, W. W., Robin, L., Washko, R. M., Noah, D. L., Barrett, D. H., Randall, B., Herwaldt, B. L., Mawle, A. C., and Reeves, W. C. Chronic Multisymptom Illness Affecting Air Force Veterans of the Gulf War. JAMA 9-16-1998;280(11):981-8.

3. Sartin, J. S. Gulf War Illnesses: Causes and Controversies. Mayo Clin Proc 2000;75(8):811-9.

4. Thompson, W. G., Lonnstreth, G. F., Drossman, D. A., Heaton, K. W., Irvine, E. J., and Muller-Lissner, S. A. Functional Bowel Disorders and Functional Abdominal Pain. Gut 1999;45(Suppl II):1143-7.

5. Talley, N. J. Functional Gastrointestinal Disorders. Grendell, James H., McQuaid, Kenneth R., and Friedman, Scott L. Current Diagnosis and Treatment in Gastroenterology. 2nd ed. Norwalk, CT: Appletone & Lange; 2003.

6. United States Department of Defense. Comprehensive Clinical Evaluation Program for Persian Gulf War Veterans: CCEP Report on 18,598 Participants. 1996.
Ref Type: Generic

7. Kang, H. K.; Dalager, N. A.; Lee, K. Y. Health Surveillance of Persian Gulf War Veterans-A Review of the DVA Persian Gulf Registry Data. 1996. Department of Veterans Affairs, unpublished report.
Ref Type: Generic

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