Gastroesophageal reflux symptoms in 9/11 survivors and workers: insights gained from tragic losses.

Survivors of the 2001 World Trade Center (WTC) attacks and the individuals who volunteered for the rescue and recovery efforts remain substantially burdened by psychological trauma and respiratory illnesses related to the environmental exposures. Gastroesophageal reflux symptoms (GERS) are also reported at higher rates than expected among this population. Post-traumatic stress disorder (PTSD) and exposures to the caustic aerosolized debris of the WTC are explored in further detail as potential mechanisms underlying these GERS experiences in WTC Registry participants. Recent work by Li and colleagues suggests that the WTC experience is associated with increases in GER independent of asthma and PTSD diagnoses. However, this association may be more complex since over-representation of hypersensitive non-acid reflux subjects and failure to completely capture psychiatric comorbidity may also contribute to our understanding of these findings. Nonetheless, the WTC Registry offers a unique study population, and detailed psychologic profiling and physiologic testing of participants may promote greater insight into gastroesophageal reflux pathohysiology.