SAN DIEGO — Workers who responded to the scene and cleaned up after the Sept. 11, 2001, attack on New York's World Trade Center continued to have high rates of gastroesophageal reflux disease and mental health disorders 4-6 years later, a study of 697 patients has shown.
The findings suggest that mental health disorders may play an important role in the development and persistence of gastroesophageal reflux disease (GERD) after a highly stressful and toxic exposure such as the environs of the World Trade Center attack, Dr. Yvette Lam said at the annual meeting of the American College of Gastroenterology.
A multidisciplinary approach to care that includes treatment of mental health disorders may be needed to resolve GERD symptoms, suggested Dr. Lam of the State University of New York, Stony Brook.
Among the 697 patients studied, 55% had responded to the disaster scene on Sept. 11, and 97% had responded by the end of that month. The patients worked at the site for an average of 4 months. More time spent at the site correlated with a higher prevalence of GERD and posttraumatic stress disorder (PTSD).
The workers encountered toxic conditions: 63% were exposed to blood or bodily fluids, 80% to human remains, and 99.5% to dust. There was no association between the type of exposure and the prevalence of GERD.
The cohort was nearly all male (92%) and ranged in age from 34 to 50 years.
Data on these patients, seen between July 2005 and September 2006, were compared with data from the general population, serving as a control group in this retrospective study. The prevalence of GERD was 41% in the World Trade Center workers and 20% in the control group. PTSD was seen in 28% of the workers and 4% of the control group. Major depressive disorders affected 31% of the workers and 7% of the control group, and anxiety was diagnosed in 46% of the workers and 3% of the control group.
In addition, the 41% of workers who had GERD were significantly more likely than workers without GERD to have PTSD (21% vs. 7%), major depression (22% vs. 9%), and anxiety (30% vs. 16%), Dr. Lam and her associates reported.
Among 413 of the workers who came in for a follow-up visit 19-31 months after the first visit, those who had GERD at the second visit were significantly more likely than those without GERD to have PTSD (21% vs. 10%) and depression (33% vs. 12%).
Patients with more mental health disorders had a higher risk for GERD. The analysis showed that the prevalence of GERD increased to 72% among the patients with four mental health disorders.
More than 40,000 police, fire fighters, contract workers, and volunteers participated in the massive rescue and cleanup efforts at Ground Zero, recovering human remains and cleaning up debris over a 9-month period. A previous study of conditions in the World Trade Center workers found a 58% prevalence of GERD, among other disorders (Int. Arch. Occup. Environ. Health 2008;81:479-85).
In another previous study, people with anxiety disorders were three times more likely to have GERD, and people with depression were twice as likely to have GERD, compared with those without those mental health diagnoses (Aliment. Pharmacol. Ther. 2007;26:683-91).