Intestinal Hyperpermeability in Gulf War Veterans With Chronic Gastrointestinal Symptoms

Abstract

Background: Well over 700,000 United States military personnel participated in the Persian Gulf War in which they developed chronic health disorders of undetermined etiology. Up to 25% of Veterans had persistent and chronic gastrointestinal (GI) symptoms, which they suspected were related to their military service in the Gulf. Aim: The overall aim of the current study was to evaluate intestinal permeability in previously deployed Gulf War Veterans who developed chronic GI symptoms during their tour in the Persian Gulf. Methods: To accomplish this, we evaluated intestinal permeability (IP) using the urinary lactulose/mannitol test. Measurements of intestinal permeability were then correlated with mean ratings of daily abdominal pain, frequency of bowel movements, and consistency of bowel movements on the Bristol Stool Scale in all Veterans. Results: A total of 73 veterans had documented chronic GI symptoms (diarrhea, abdominal pain) and were included in the study. A total of 29/73 (39%) of veterans has increased IP and had a higher average daily stool frequency (P<0.05); increased liquid stools as indicated by a higher Bristol Stool Scale (P<0.01); and a higher mean M-VAS abdominal pain rating (P<0.01). Pearson correlation coefficients revealed that there was a positive correlation between increased IP and stool frequency, Bristol Stool Scale, and M-VAS abdominal pain rating. Conclusions: Our study demonstrates that deployed Gulf War Veterans with persistent GI symptoms commonly have increased intestinal permeability that potentiates the severity of abdominal pain, diarrhea, and stool consistency. These new findings in our study are important as they may lead to novel diagnostic biomarkers for returning Gulf War Veterans who suffer from chronic functional gastrointestinal disorders. These advances are also important for an increasing number of veterans who are now serving in the Persian Gulf and are at a high risk of developing these chronic pain disorders.

IL-17 and IL-17C Signaling Protects the Intestinal Epithelium against Diisopropyl Fluorophosphate Exposure in an Acute Model of Gulf War Veterans' Illnesses

“…In a recent study incorporating all service branches, IBS was found to afflict close to 20% of Gulf War Veterans ( 6 ). Furthermore, GWI Veterans with chronic GI symptoms were found to exhibit intestinal epithelial hyperpermeability ( 7 ), which is consistent with IBS.…”

“…Antimicrobial peptide (AMP) secretion by intestinal epithelial cells (IEC) is critical for regulating microbial colonization as dysregulation can lead to dysbiosis ( 15 ) and contribute to inflammatory bowel disease and IBS ( 16 ). Altered intestinal permeability has also been extensively linked to IBS, especially for post-infectious IBS ( 8 ) and for GWI Veterans ( 7 ). The formation of tight junctions between IECs in the gut barrier plays a significant role in regulating intestinal permeability ( 17 ).…”

Host Akkermansia muciniphila Abundance Correlates With Gulf War Illness Symptom Persistence via NLRP3-Mediated Neuroinflammation and Decreased Brain-Derived Neurotrophic Factor

“…29,31 This condition of compromised gut barrier integrity has also been reported among veterans who suffer from gastrointestinal problems in GWI. 55 Moreover, a recent study by Janulewicz et al 56 showed that GWI afflicted veterans with gastrointestinal disturbances present gut dysbiosis among bacteria of the phylum Verrucomicrobia. Interestingly, A muciniphila belongs to the same phylum.…”

Gastrointestinal problems, mechanisms and possible therapeutic directions in Gulf war illness: a mini review

“…Among GW veterans, the study by Zhang et al [8] reports intestinal hyperpermeability in veterans who report GI symptoms. The study worked with veterans from The Cincinnati Veterans Affairs Medical Center (VAMC) in Cincinnati, OH and the Malcom Randall VAMC in Gainesville, FL.…”