Enduring association between irritable bowel syndrome and war trauma during the Nicaragua civil war period: A population-based study.

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.

Irritable bowel syndrome and gastrointestinal parasite infection in a developing nation environment.

Postinfectious IBS is defined in the industrialized world as IBS onset following a sentinel gastrointestinal infection. In developing nations, where repeated bacterial and parasitic gastrointestinal infections are common, the IBS pathophysiology may be altered. Our aim was to investigate the relationship between intestinal parasite infection and IBS in the "nonsterile" developing world environment. IBS subjects were identified from a population-based sample of 1624 participants using the Rome II Modular Questionnaire. Stool samples from cases and randomly selected controls were examined for ova and parasites. Logistic regression models explored the relationship between IBS and parasite infection. The overall IBS prevalence among participants was 13.2% (9.3% males, 15.9% females). There was no difference in parasite carriage between IBS cases and controls, 16.6% versus 15.4% (P = 0.78), nor among IBS subtypes. The pathophysiology of post-infectious IBS may be altered in the developing world as compared to industrialized nations and warrants investigation.

Association between intimate partner violence and irritable bowel syndrome: a population-based study in Nicaragua.

Irritable bowel syndrome (IBS) is a disabling functional gastrointestinal disorder, which serves as a model for abdominal pain syndromes. An association between intimate partner violence and IBS has been shown among White women in the industrialized world. To determine whether this relationship transcends cultural boundaries, we conducted a population-based, cross-sectional survey in Nicaragua using the innovative Health and Demographic Surveillance System in the León province. Women who had experienced physical intimate partner violence had significantly increased risk of IBS (odds ratio [OR] = 2.08; 95% confidence interval [CI] = 1.35, 3.21), as did those who had experienced sexual intimate partner violence (OR = 2.85; 95% CI = 1.45, 5.59). These findings argue for intimate partner violence screening among Latina women with IBS.