Reflux symptoms and disorders and pulmonary disease in former World Trade Center rescue and recovery workers and volunteers.
BACKGROUND
Gastroesophageal reflux disease is one of the most prevalent conditions among former World Trade Center (WTC) rescue and recovery workers. The reason for this proposed association with an inhalation injury is unclear. In this study, we clinically characterized the reflux disorders in former WTC workers, and we investigated their association with pulmonary function abnormalities and with clinical diagnoses of other WTC-related diseases.


METHODS
Forty-two former WTC workers underwent the following testing: symptom inventories, physical examination, spirometry, esophagogastroduodenoscopy, and 24-hour pH monitoring studies for the evaluation of chronic reflux-like symptoms. Patients were classified into two groups based on clinical evaluation: group 1 (reflux patients) including definitive reflux disorders (gastroesophageal reflux, nonerosive reflux, nonacid reflux, and laryngopharyngeal reflux diseases) and group 2 (no-reflux patients) patients without clinically significant reflux disease, including functional heartburn, and hypersensitive esophagus disorder.


RESULTS
The reflux and no-reflux patients had significantly different Johnson-DeMeester scores and esophageal acid exposure times. Patients with reflux disorders were more likely to have reduced forced vital capacity (chi2 = 5.49, P = 0.031) and also more likely to have been diagnosed with a lower airway disease (chi2 = 7.14, P = 0.008). We found no significant association between reflux and psychiatric disorders (chi2 = 0.02, P = 0.89), levels of exposure at the WTC site, or incidence of dry cough, or other upper airway disorders.


CONCLUSIONS
A spectrum of reflux symptoms and disorders are present in WTC responders. Our data suggest that the presence of reflux disease is related to that of pulmonary function abnormality suggestive of air trapping and a diagnosis of a lower respiratory disease.
de la Hoz
Rafael E
RE
Department of Community and Preventive Medicine, The Mount Sinai School of Medicine, New York, NY 10029, USA. rafael.delahoz@mssm.edu
Christie
Jennifer
J
Teamer
Jelani A
JA
Bienenfeld
Laura A
LA
Afilaka
Aboaba A
AA
Crane
Michael
M
Levin
Stephen M
SM
Herbert
Robin
R
D000328:Adult; D016145:Endoscopy, Digestive System; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D001239:Inhalation; D008171:Lung Diseases / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects*; D018635:Rescue Work; D047851:September 11 Terrorist Attacks; D014797:Vital Capacity