Department of Veterans Affairs Testimony

Testimony regarding FR Docket No. 2012-710: review of VA program activities related to Gulf War Veterans' illnesses, updates on relevant scientific research, and discussion of the Gulf War Research Strategic Plan being prepared in VA's Office of Research and Development

Written Statement of William F. Norton, Vice President, International Foundation for Functional Gastrointestinal Disorders (IFFGD). 

Submitted to the Department of Veterans Affairs (VA), Research Advisory Committee on Gulf War Veterans' Illnesses on January 30, 2012.

Thank you for the opportunity to present this written statement regarding the importance of functional gastrointestinal disorders research related to Gulf War Veterans’ Illnesses.

On behalf of the International Foundation for Functional Gastrointestinal Disorders (IFFGD), I would like to thank the Committee for its work to understand the health consequences of military service in the Southwest Asia theater of operations during the Gulf War, and to help the veterans with service connected diseases. IFFGD is a 501(c)(3) nonprofit education and research organization. Since 1991 we have been dedicated to improving the understanding of functional gastrointestinal disorders. Our mission is to inform, assist, and support people affected by these painful and debilitating digestive conditions for which too few treatment options exist.

We are grateful to the VA for its leadership in recognizing the burden of illness that functional gastrointestinal disorders (FGIDs) have on affected individuals and taking steps to help relieve that burden. Among these steps is the 2011 VA issued “Presumptive Service Connection,” rule recognizing the positive association between service in Southwest Asia during certain periods and the development of functional GI disorders.

The onset of a functional GI disorder (FGID) 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 a FGID as a result of their service. The relationship between service-related deployment and the onset of a FGID is documented in medical literature, including the 2010 Institute of Medicine (IOM) report entitled, Gulf War and Health Volume 8: Update of Health Effects of Serving in the Gulf War.

Functional GI disorders are conditions where normal movement of the intestines, sensitivity of the nerves of the intestines, or the way in which the brain controls some of these functions is impaired. The conditions can affect any area of the GI tract, from the esophagus to the stomach to the small and large intestines. They are characterized by long-term courses, unpredictable symptom episodes, and sometimes disabling effects. No structural abnormalities are found and routine diagnostic tests such as endoscopies, x-rays, or blood tests are normal. Diagnosis is based on characteristic symptoms that meet defined criteria. Functional GI disorders make up the majority of GI conditions diagnosed by physicians in primary care and in gastroenterology. Few effective therapies exist and these do not always work for all persons. Treatment focuses on management over a long term.

Functional GI disorders are challenging to patients and physicians. In clinics, patients with FGIDs have normal diagnostic tests. The symptoms are variable, their onset often unpredictable, and their course can vary over time. These variations occur both within an individual, and also from person to person with the same diagnosis. The disorders are influenced by multiple factors, including genetic makeup, environmental influences, and psychological and social factors. The conditions do not fit the traditional linear biomedical model. Consequently, patients often struggle, sometimes for years, to obtain the accurate diagnosis necessary to begin appropriate treatment. Moreover, adequate treatment for functional GI disorders is lacking. All of the above factors contribute to uncertainties that challenge both affected individuals and their physicians.

The current effort to expand benefits to veterans with functional GI disorders by VA underscores the need for bolstered research in this area. Currently, our scientific understanding of functional GI disorders is limited. As a result, there are no cures and treatment options mainly focus on symptom management with varying degrees of effectiveness depending on the individual patient. Since these conditions are often chronic and treatment options are limited, they are costly to treat and individuals on disability may have little hope of returning to a productive lifestyle.

Recommendations

IFFGD makes the following suggestions regarding functional gastrointestinal disorders, which we urge you to consider in recommendations you provide to the Secretary of Veterans Affairs regarding proposed research strategies and plans addressing Gulf War Illnesses:

• Streamline logistics set up to harmonize the patient data collected by the Department of Defense (DOD) with data collected by the VA.
• Provide investigators with direct access to harmonized patient data and develop questionnaires and other kinds of assessments for tracking FGID patients longitudinally to understand how they are changing, or developing new symptoms or syndromes.
• Educate and increase awareness of these conditions among care providers to facilitate prompt, accurate diagnoses and treatments.
• Educate and increase awareness of these conditions among active duty soldiers and veterans deployed to the Persian Gulf region; work with patient organizations and the National Institutes of Health (NIH) to assist with these efforts.
• Explore opportunities to partner with the NIH to enhance research and improve patient care.

Thank you for your consideration of our comments.