Prevalence of Gastrointestinal Problems in Occupations: A Retrospective Study : Journal of Occupational and Environmental Medicine

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Letters to the Editor

Prevalence of Gastrointestinal Problems in Occupations

A Retrospective Study

Mark, H. Hyman MD; Samantha, Wu BS, BA; Hamed, Hafizi BS; Yihang, Liu MD MS

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Journal of Occupational and Environmental Medicine 53(2):p 117, February 2011. | DOI: 10.1097/JOM.0b013e318209e1a3
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To the Editor:

The introduction and use of capsule endoscopy has revolutionized methods for gastrointestinal (GI) tract disease detection. Small bowel capsule endoscopy provides patients with a noninvasive option for viewing and detecting GI problems in the small intestines.1 More recently, the use of esophageal capsule endoscopy (ECE) offers patients a similar noninvasive means for evaluating esophageal diseases.2,3 Since ECE is noninvasive and painless and does not infringe upon the regular daily activities of patients after the procedure, it is an advantageous means of visualizing the esophagus without the need for sedation.47

While there are many studies on the use of small bowel capsule endoscopies, research done on ECE is still limited. We conducted a retrospective review of 285 medical records on individuals who underwent ECE to provide additional information on existing research. Most importantly, this review demonstrated occupational correlations with various esophageal diseases (such as gastroesophageal reflux disease [GERD], hiatal hernia) and compared trends among workers’ compensation cases.

Variables (ie, alcohol use, smoking, caffeine use, body mass index, comorbidities, and medications used) were studied in occupations such as police/deputy sheriff, firefighter, professional athlete, civil servant, manual laborer, clerical, or others. In addition, we also studied possible relationships between potential risk factors and major GI diagnosis (eg, GERD, Helicobacter pylori).

Results show that the largest prevalence of total abnormal ECE results was in manual labor-intensive jobs (35.5%). In terms of the prevalence of specific GI disorders, hiatal hernias were present in the highest frequency (72 individuals), followed by GERD grade 1 (56 individuals). Alcohol consumption was a marginally significant positive correlate with hiatal hernias (P = 0.0846), and cigarette use displayed the strongest positive correlation with GERD grade 1 ECE results (P = 0.0155). In addition, results showed that being overweight or obese was significantly associated with an abnormal ECE diagnosis (40.8% and 54.4%, respectively), while only 33.3% of the subjects who had normal weights attained abnormal CE diagnoses (P = 0.009).

The study of results from ECE demonstrated a difference in the number of abnormal GI problems in individuals with different occupations. Subjects involved with manual labor such as factory, construction, or farm work showed the highest number of abnormal GI problems overall and within each category.

Additional results for this study showed significant positive correlations between smoking and alcohol consumption with GERD (ie, grade 1) and hiatal hernia, respectively. As a result, individuals with these habits are likely candidates for developing GI problems and preventive interventions targeting this working population may be a consideration.


This study was supported by the American Academy of Disability Evaluating Physicians, Veritas Medicus Fund, and private funding from one of the authors (M.H.H.).


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