Fiscal Year 2013

Testimony regarding Fiscal Year 2013 appropriations for the Department of Defense (DOD) Gulf War Illness Research Program

Presented by: Elisabeth Vink, Program Specialist, International Foundation for Functional Gastrointestinal Disorders (IFFGD).  

Presented to: U.S Senate Appropriations Committee, Subcommittee On Defense on June 6, 2012.

Thank you for the opportunity to present the views of the International Foundation for Functional Gastrointestinal Disorders (IFFGD) regarding functional gastrointestinal disorders (FGIDs) among service personnel and veterans. FGIDs are recognized by the Department of Veterans Affairs (VA) as disabling and connected to military service as a part of Gulf War Illness, and we request that that the Subcommittee continue support the Department of Defense (DOD) Gulf War Illness Research Program through the Congressionally Directed Medical Research Program. I am a proud member of a military family, with my father having served 23 years in the U.S. Air Force, and I appreciate the opportunity to present testimony in support of veterans like my dad.

Established in 1991, IFFGD is a patient-driven nonprofit organization dedicated to assisting individuals affected by FGIDs, and providing education and support for patients, healthcare providers, and the public at large. Our mission is to inform and support people affected by painful and debilitating digestive conditions, about which little is understood and few (if any) treatment options exist. The IFFGD also works to advance critical research on functional GI and motility disorders, in order to provide patients with better treatment options, and to eventually find a cure.

FGIDs are disorders in which the movement of the intestines, the sensitivity of the nerves of the intestines, or the way in which the brain controls intestinal function is impaired. People who suffer from FGIDs have no structural abnormality, which makes it difficult to identify their condition using X-rays, blood tests or endoscopies. Instead, FGIDs are typically identified and defined by the collection of symptoms experienced by the patient. For this reason, it is not uncommon for FGID suffers to have unnecessary surgery, medication, and medical devices before receiving a proper diagnosis.

Over two dozen different FGIDs have been identified. Severity ranges from bothersome to disabling and life-altering. The conditions may strike anywhere along the gastrointestinal tract, from nausea and vomiting to altered bowel habit. Examples of FGIDs include irritable bowel syndrome (IBS) and functional dyspepsia. IBS is characterized by abdominal pain and discomfort associated with a change in bowel pattern, such as diarrhea and/or constipation. Symptoms of functional dyspepsia usually include an upset stomach, pain in the belly, and bloating.

FGIDs can be emotionally and physically debilitating. Due to persistent pain and bowel unpredictability, individuals who suffer from these disorders may distance themselves from social events, work, and even may fear leaving their home. Stigma surrounding bowel habits may act as barrier to treatment, as patients are not comfortable discussing their symptoms with doctors.

The onset of a functional GI disorder can be triggered by severe stress and infections of the digestive system. Deployed military personnel face an elevated chance of experiencing these risk factors and developing FGIDs as a result of their service. In April 2010, the Institute of Medicine (IOM) published a report titled Gulf War and Health, Volume 8: Update on the Health Effects of Serving in the Gulf War, which determined that there is sufficient evidence to associate deployment to the Gulf War and FGIDs. According to the report, there have been a large number of FGID cases among Gulf War veterans, and their symptoms have continued to be persistent in the years since the war. The IOM report focused on the incidence of GI disorders among veterans and did not attempt to determine causality. However, the report provides compelling evidence linking exposure to enteric pathogens during deployment and the development of FGIDs. The IOM recommended that further research be conducted on this association.

Based on the report from IOM, VA adopted a final rule on August 15, 2011, stating that there is a presumptive service connection between FGIDs and service in the Southwest Asia Theater of Operations during the Persian Gulf War. This includes conditions like IBS and functional dyspepsia.

At IFFGD we hear from numerous veterans about their difficulties with FGIDs, including conditions such as IBS and cyclic vomiting syndrome. Our military personnel are taught to put duty first, and at IFFGD we have noticed that by the time they reach out to us, their situation is usually pretty bad. Not only are these disorders hard to treat, but in the words of one retired Sergeant, these “sometimes very embarrassing GI disorders” are just as hard to talk about. In order to better articulate the suffering associated with FGIDs, I would like to share with you the voices of veterans affected by these disorders. This is from Stephen in North Carolina: 

I am a Desert Shield/Desert Storm veteran that served in the Persian Gulf Theater of operations from August 1990 to March 1991, as the G2 Sergeant Major for the 24th Infantry Division. While there, and since my return, I have been plagued with a multitude of GI problems including IBS, a functional GI problem. I suffered nearly constant diarrhea for over ten years before the IBS was ever diagnosed. None of my GI problems existed prior to my deployment and they simply do not seem to go away afterwards." 

This is from Jason, who contacted us earlier this year: 

I am a disabled Iraq veteran that was deployed during 2003-2005 timeframe with a National Guard unit attached to active duty. Since returning from Iraq, I have had issues with my gastrointestinal tract. I have made a few attempts to try to pinpoint the cause of this change in my bodily function to no avail. … While speaking with several of my former soldiers I came to realize that they are experiencing the same signs and symptoms. I am the first one of a group of friends/vets that is doing research to find out that we are not alone." 

The DOD Gulf War Illness Research Program conducts important research on the complex set of chronic symptoms that impact Gulf War Veterans. Given the conclusions of the IOM report and the report’s recommendations for further research on the link between FGIDs and exposures experienced by veterans in the Gulf War, we ask that you continue to support the Gulf War Illness Research Program and encourage research into FGIDs through this program so that important research on FGIDs among veterans can be conducted.

Thank you again for the opportunity to address the Subcommittee.