Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2023; 29(45): 5953-5961
Published online Dec 7, 2023. doi: 10.3748/wjg.v29.i45.5953
Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study
Edgar M Peña-Galo, Daniel Wurzelmann, Javier Alcedo, Rodolfo Peña, Loreto Cortes, Douglas Morgan
Edgar M Peña-Galo, Javier Alcedo, Department of Digestive Diseases, Miguel Servet University Hospital, Zaragoza 50009, Aragon, Spain
Edgar M Peña-Galo, Javier Alcedo, Aragon Health Research Institute, IIS Aragon, Zaragoza 50009, Aragon, Spain
Daniel Wurzelmann, Department of Mental Health, Carolina Partners, Durham, NC 27707, United States
Rodolfo Peña, Department of Data Analysis, CIDE (Research, Development and Epidemiology Center), Tegucigalpa 11101, Francisco Morazán, Honduras
Loreto Cortes, School of Medicine, National Autonomous University of Nicaragua, Leon 21000, Leon, Nicaragua
Douglas Morgan, Department of Gastroenterology and Hepatology, UAB University of Alabama Birmingham, Birmingham, AL 35233, United States
Douglas Morgan, School of Medcine, The University of North Carolina, Chapel Hill, NC 9500, United States
Author contributions: Morgan D and Peña R designed the research; Peña-Galo EM, Peña R, and Cortes L contributed with data acquisition; Peña-Galo EM, Wurzelmann D, Peña R, Alcedo J, and Morgan D analyzed and interpreted of data; Morgan D, and Peña EM wrote manuscript; Peña-Galo EM, Peña R, Alcedo J, Wurzelmann D, Cortes L, and Morgan D performed a critical review.
Supported by the UNC UNAN FGID Epidemiology Study Project, No. 54-1808958.
Institutional review board statement: This study was approved by the Institutional Review Boards of the University of North Carolina, Chapel Hill (#02-MED-461) and UNAN-Leon. All Good Clinical Practice (GCP) standards were followed, including informed consent with each subject, participant confidentiality and anonymized data.
Conflict-of-interest statement: There were no conflicts of interest with respect to industry or government.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Douglas Morgan, FACG, MD, Director, Professor, Department of Gastroenterology and Hepatology, UAB University of Alabama Birmingham, No. 373 Boshell Bldg, UAB, Birmingham, AL 35233, United States. drmorgan@uabmc.edu
Received: July 7, 2023
Peer-review started: July 7, 2023
First decision: August 8, 2023
Revised: September 13, 2023
Accepted: November 27, 2023
Article in press: November 27, 2023
Published online: December 7, 2023
Processing time: 147 Days and 3.5 Hours
Abstract
BACKGROUND

Psychosocial and physical trauma are known risk factors for irritable bowel syndrome (IBS), including in war veterans, whereas war exposure in civilians is unclear. Nicaragua experienced two wars, 1970-1990: The Sandinistas Revolution (1970s) and The Contra War (1980s). Our aim was to investigate the role of exposure to war trauma in the subsequent development of IBS in the context of an established health surveillance system (11000 households).

AIM

To investigate in a civilian population the relationship between exposure to war trauma and events and the subsequent development of IBS in the context of an established public health and demographic surveillance system in western Nicaragua.

METHODS

We conducted a nested population-based, cross-sectional study focused on functional gastrointestinal disorders based on Rome II criteria. 1617 adults were randomly selected. The Spanish Rome II Modular Questionnaire and Harvard Trauma Questionnaire were validated in Nicaragua. War exposure was assessed with 10 measures of direct and indirect war trauma and post-war effects. Multiple exposures were defined by ≥ 3 measures.

RESULTS

The prevalence of IBS was 15.2% [Female (F) 17.1%, Male (M) 12.0%], war exposure 19.3% (F 9.3%, M 36.7%), and post-traumatic stress disorder (PTSD) 5.6% (F 6.4%, M 4.3%). Significant associations with IBS in the civilian population were observed (adjusted by gender, age, socioeconomic status, education): physical and psychological abuse [adjusted odds ratio (aOR): 2.25; 95% confidence interval: 1.1-4.5], witnessed execution (aOR: 2.4; 1.1-5.2), family member death (aOR: 2.2; 1.2-4.2), and multiple exposures (aOR: 2.7; 1.4-5.1). PTSD was independently associated with IBS (aOR: 2.6; 1.2-5.7).

CONCLUSION

An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS. Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.

Keywords: Irritable bowel syndrome; Functional gastrointestinal disorders; War trauma; Civil war; Post-traumatic stress disorder; Central America

Core Tip: What is known: Psychosocial and physical trauma are known risk factors for irritable bowel syndrome (IBS), including in war veterans. What is new: An enduring association was observed in the Nicaragua civilian population between specific civil war-related events and subsequent IBS. Civilian populations in regions with extended armed conflict may warrant provider education and targeted interventions for patients.