title: Gastroesophageal reflux symptoms and comorbid asthma and posttraumatic stress disorder following the 9/11 terrorist attacks on World Trade Center in New York City.
abstract: OBJECTIVE
  Excess gastroesophageal reflux disease (GERD) was reported in several populations exposed to the September 11 2001 (9/11) terrorist attacks on the World Trade Center (WTC). We examined new onset gastroesophageal reflux symptoms (GERS) since 9/11 and persisting up to 5-6 years in relation to 9/11-related exposures among the WTC Health Registry enrollees, and potential associations with comorbid asthma and posttraumatic stress disorder (PTSD).
  
  
  METHODS
  This is a retrospective analysis of 37,118 adult enrollees (i.e., rescue/recovery workers, local residents, area workers, and passersby in lower Manhattan on 9/11) who reported no pre-9/11 GERS and who participated in two Registry surveys 2-3 and 5-6 years after 9/11. Post-9/11 GERS (new onset since 9/11) reported at first survey, and persistent GERS (post-9/11 GERS reported at both surveys) were analyzed using log-binomial regression.
  
  
  RESULTS
  Cumulative incidence was 20% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). Among enrollees with neither asthma nor PTSD, the adjusted risk ratio (aRR) for persistent GERS was elevated among: workers arriving at the WTC pile on 9/11 (aRR=1.6; 95% confidence interval (CI) 1.3-2.1) or working at the WTC site > 90 days (aRR=1.6; 1.4-2.0); residents exposed to the intense dust cloud on 9/11 (aRR=1.5; 1.0-2.3), or who did not evacuate their homes (aRR=1.7; 1.2-2.3); and area workers exposed to the intense dust cloud (aRR=1.5; 1.2-1.8).
  
  
  CONCLUSIONS
  Disaster-related environmental exposures may contribute to the development of GERS. GERS may be accentuated in the presence of asthma or PTSD.
authors: New York City Department of Health and Mental Hygiene, New York, New York 11101, USA. jli3@health.nyc.gov
authors: Jiehui
authors: J
authors: Li
authors: Robert M
authors: RM
authors: Brackbill
authors: Steven D
authors: SD
authors: Stellman
authors: Mark R
authors: MR
authors: Farfel
authors: Sara A
authors: SA
authors: Miller-Archie
authors: Stephen
authors: S
authors: Friedman
authors: Deborah J
authors: DJ
authors: Walker
authors: Lorna E
authors: LE
authors: Thorpe
authors: James
authors: J
authors: Cone
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000393:Air Pollutants; D001249:Asthma / Q000150:complications*; D004391:Dust; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D019570:Inhalation Exposure; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D047851:September 11 Terrorist Attacks / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D004391:Dust