Risk analysis of upper gastrointestinal tract disorders in the health preservation strategy among the military personnel involved in combat operations

Relevance. Professional health preservation in the military personnel is a pivotal objective of military medicine. The current situation demonstrates a shortage of comprehensive data regarding the risk factors contributing to the development of upper digestive tract pathologies among combatants.

The objective is to assess the apparent prevalence of upper gastrointestinal tract diseases including both newly diagnosed cases and exacerbations of pre–existing conditions by evaluating the impact, quantity, and intensity of specific risk factors among servicemen of the Russian National Guard operating under different military service conditions, with a focus on combatants.

Methods. The study enrolled the military personnel (n = 256) of the Russian National Guard North Caucasus District who are characterized by a complicated gastrointestinal history, including 118 combatants and 138 non–combatants. The groups were formed randomly as the patients were admitted to hospital for treatment and rehabilitation. Based on the incidence data from February 2022 to February 2023, the prevalence of upper gastrointestinal tract diseases (Chapter XI of the International Classification of Diseases and Related Health Problems, ICD–10) was assessed by frequency analysis using contingency tables. The epidemiological significance of risk factors was evaluated using attributable risk metrics, including attributable fraction, relative risk, and odds ratio.

Results and analysis. Comparative incidence of gastrointestinal diseases showed a higher prevalence of isolated and combined acute erosive and ulcerative lesions of the esophageal, gastric, and duodenal mucosa, as well as chronic duodenal ulcers (K20–K31 in the ICD–10) among combatants, predominantly observed in career officers 93 (79 %). Meanwhile, in the control group, chronic peptic ulcer disease was more prevalent (41 %), with fewer cases of combined erosive and ulcerative lesions (7 %), likewise predominantly among career officers (29 %). These observed clinical and epidemiological patterns and statistically significant group differences were not random, but linked to specific risk factors. Risk analysis in the combatant group confirmed the significance of 11 controllable risk factors (total attributable weight 43 %) and 9 partially controllable factors (total attributable weight 33 %) contributing to the development of the identified gastrointestinal pathologies.

Conclusion. Understanding the dynamics in the prevalence of upper gastrointestinal tract diseases considering both new cases and exacerbations of existing conditions and their association with specific risk factors, including their number and intensity of impact in the examined military personnel of the Russian Guard deployed for military service under various conditions (using combat veterans as an example) provides a framework for further risk management strategies. This approach is essential to reduce the incidence of digestive system diseases among military personnel and is a critical component of health preservation strategies in combat environments.

1. Bikkinina G.M., Mingazova L.R. Obosnovanie podhodov k realizacii preventivnyh meroprijatij professional’no-obuslovlennoj patologii u sotrudnikov silovyh struktur [Justification of approaches to the implementation of preventive measures for professionally conditioned pathology in law enforcement officers]. Sibirskij medicinskij zhurnal [Siberian Medical Journal]. 2011; 26(4-1):166–170 (In Russ.)

2. Bolkiseva P.S., Fazylzjanova A.R., Jamshhikova T.V. [et al.]. Vyjavlenie faktorov riska vozniknovenija zabolevanij organov pishhevarenija [Identification of risk factors for the occurrence of diseases of the digestive system]. Modern science [Modern science]. 2020; 12(2):48–50. (In Russ.)

3. Dampilova N.Ju. Bolezni organov pishhevarenija u voennosluzhashhih-uchastnikov likvidacii posledstvij Chernobyl’skoj katastrofy [Diseases of the digestive system in military personnel participating in the liquidation of the consequences of the Chernobyl disaster: dissertation abstract]. St. Petersburg. 2010. 21 p. (In Russ.)

4. Denega V.I., Fadeev A.V., Kruchinina N.E. [et al.]. Sravnitel’naja harakteristika nekotoryh faktorov patogeneza hronicheskoj gastroduodenal’noj patologii u voennosluzhashhih razlichnyh professional’nyh grupp [Comparative characteristics of some factors of the pathogenesis of chronic gastroduodenal pathology in military personnel of various professional groups]. Voenno-medicinskij zhurnal [Military medical journal]. 2006; 327(4):29–96. (In Russ.)

5. Evdokimov V.I., Sivashhenko P.P., Grigor’ev S.G. Pokazateli zabolevaemosti voennosluzhashhih kontraktnoj sluzhby Vooruzhennyh sil Rossijskoj Federacii (2003–2016 gg.) [Indicators of morbidity among contract soldiers of the Armed Forces of the Russian Federation (2003–2016): monograph]. St. Petersburg. 2018. 80 p. (In Russ.)

6. Evdokimov V.I., Sivashhenko P.P., Grigor’ev S.G. Pokazateli zabolevaemosti ofitserov Vooruzhennyh sil Rossijskoj Federacii (2003–2016 gg.) [Indicators of morbidity among officers of the Armed forces of the Russian Federation (2003–2016): monograph]. St. Petersburg. 2018. 80 p. (In Russ.)

7. Evdokimov V.I., Sivashhenko P.P., Grigor’ev S.G., Emel’janov A.Ju. Rol’ osnovnyh boleznej v formirovanii pokazatelej zabolevaemosti oficerov Vooruzhennyh sil Rossii v 2003–2016 gg. [The role of major diseases in forming the morbidity indicators in officers of the Russian armed forces in 2003–2016]. Mediko-biologicheskie i social’no-psihologicheskie problem bezopasnosti v chrezvychajnyh situacijah [Medico-Biological and Socio-Psychological Problems of Safety in Emergency Situations]. 2018; (1):19–29. DOI: 10.25016/2541-7487-2018-0-1-19-29. (In Russ.)

8. Eganjan R.A., Kushunina D.V., Kalinina A.M. Aktual’nost’ i rezul’tativnost’ rannego vyjavlenija zabolevanij organov pishhevarenija pri dispanserizacii vzroslogo naselenija Rossii [The relevance and effectiveness of early detection of diseases of the digestive system in the medical examination of the adult population of Russia]. Profilakticheskaja medicina [Profilakticheskaya medicine]. 2017; 20(3):22–27. DOI: 10.17116/profmed201720322-27. (In Russ.)

9. Ivashkin V.T., Maev I.V., Car’kov P.V. [et al.]. Diagnostika i lechenie jazvennoj bolezni u vzroslyh (Klinicheskie rekomendacii Rossijskoj gastrojenterologicheskoj associacii, Rossijskogo obshhestva kolorektal’nyh hirurgov i Rossijskogo jendoskopicheskogo obshhestva) [Diagnosis and treatment of peptic ulcer disease in adults (Clinical recommendations of the Russian gastroenterological association, the Russian society of colorectal surgeons and the Russian endoscopic society]. Rossijskij zhurnal gastrojenterologii, gepatologii, koloproktologii [Russian Journal of Gastroenterology, Hepatology, Coloproctology]. 2020; 30(1):49–70. DOI: 10.22416/1382-4376-2020-30-1-49-70. (In Russ.)

10. Kartashov I.G. Uslovija zhizni voennosluzhashhih po kontraktu kak faktor ih zdorov’ja [Living conditions of contract military personnel as a factor in their health]. Voennaja sociologija [Military Sociology]. 2008; (2):118–122. (In Russ.)

11. Kvasov S.E., Podushkina I.V., Abanin A.M. [et al.]. Donozologicheskaja diagnostika kak metodologicheskoe obosnovanie potrebnosti v obuchajushhih programmah po zdorovomu obrazu zhizni u voennosluzhashhih silovyh vedomstv [Prenosological diagnostics as a methodological substantiation of the need for training programs on a healthy lifestyle among military personnel of law enforcement agencies]. Medicinskij al’manah [Medical almanah]. 2010; 3(12):22–26. (In Russ.)

12. Kotova E.G., Aleksandrova G.A., Kobjakova O.S. [et al.]. Obshhaja zabolevaemost’ vzroslogo naselenija Rossii v 2021 godu: statisticheskie materialy [General morbidity rate of the adult population of Russia in 2021: statistical materials: monograph]. Moscow. 2022. 164 р. (In Russ.)

13. Lizunov Ju.V., Erofeev V.G. Vozmozhnye faktory riska dlja zdorov’ja voennosluzhashhih v uslovijah lokal’nyh vooruzhennyh konfliktov [Possible risk factors for the health of military personnel in local armed conflicts]. Vestnik Rossijskoj voennomedicinskoj akademii [Bulletin of the Russian Military Medical Academy]. 2018; (1):102–104. (In Russ.)

14. Miridzhanjan G.M. Monitoring faktorov riska razvitija boleznej organov pishhevarenija (po materialam issledovanija v g. Erevane, Armenija) [Monitoring risk factors for the development of diseases of the digestive system (based on materials from a study in Yerevan, Armenia]. Remedium [Remedium]. 2017; (6):20–23 (In Russ.)

15. Papushin O.N. Vlijanie faktorov voennoj sluzhby na techenie gastro-jezofagel’noj refljuksnoj bolezni [The influence of military service factors on the course of gastroesophageal reflux disease: dissertation abstract]. Moscow. 2007. 21 p. (In Russ.)

16. World Health statistics 2014. Geneva: WHO. 2014. 177 p.

17. Fletcher R.H., Fletcher S.W., Fletcher G.S. Clinical Epidemiology. The Essentials: 5th Edition. Lippincott Williams & Wilkins, a Wolters Kluwer business. 2014. 255 p.