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- Title
Combat-training increases intestinal permeability, immune activation and gastrointestinal symptoms in soldiers.
- Authors
Li, X.; Kan, E. M.; Lu, J.; Cao, Y.; Wong, R. K.; Keshavarzian, A.; Wilder‐Smith, C. H.
- Abstract
Background Gastrointestinal ( GI) symptoms are common in soldiers in combat or high-pressure operational situations and often lead to compromised performance. Underlying mechanisms are unclear, but neuroendocrine dysregulation, immune activation and increased intestinal permeability may be involved in stress-related GI dysfunction. Aim To study the effects of prolonged, intense, mixed psychological and physical stress on intestinal permeability, systemic inflammatory and stress markers in soldiers during high-intensity combat-training. Methods In 37 male army medical rapid response troops, GI symptoms, stress markers, segmental intestinal permeability using the 4-sugar test (sucrose, lactulose, mannitol and sucralose) and immune activation were assessed during the 4th week of an intense combat-training and a rest period. Results Combat-training elicited higher stress, anxiety and depression scores (all P < 0.01) as well as greater incidence and severity of GI symptoms [irritable bowel syndrome symptom severity score ( IBS- SSS), P < 0.05] compared with rest. The IBS- SSS correlated with depression ( r = 0.41, P < 0.01) and stress ( r = 0.40, P < 0.01) ratings. Serum levels of cortisol, interleukin-6, and tumour necrosis factor-α, and segmental GI permeability increased during combat-training compared with rest (all P < 0.05). The lactulose:mannitol ratio was higher in soldiers with GI symptoms ( IBS- SSS ≥75) during combat-training than those without ( IBS- SSS <75) ( P < 0.05). Conclusions Prolonged combat-training not only induces the expected increases in stress, anxiety and depression, but also GI symptoms, pro-inflammatory immune activation and increased intestinal permeability. Identification of subgroups of individuals at high-risk of GI compromise and of long-term deleterious effects of operational stress as well as the development of protective measures will be the focus of future studies.
- Subjects
MILITARY personnel; PERMEABILITY (Biology); IMMUNE system; GASTROINTESTINAL diseases; COMBAT; PHYSIOLOGY
- Publication
Alimentary Pharmacology & Therapeutics, 2013, Vol 37, Issue 8, p799
- ISSN
0269-2813
- Publication type
Article
- DOI
10.1111/apt.12269