Looking back at the history of human wars, we can find out that many troops were defeated because of diseases. According to annual statistics from the United States Naval Medical Service, during World War I, gastrointestinal diseases were the third most common diseases that led to American navy servicemen’s medical admissions. In World War II, both the American army and navy had a large number of hospital admissions for digestive disorders which were the third most common in the medical diseases[1-3].Digestive diseases were the fourth most common medical disease that caused American navy’s hospital admissions during the Korean War.And gastrointestinal diseases were again the third most common diseases that led to American navy servicemen’s medical admissions during the Vietnam War.Judging from disease attrition of Chinese army in previous wars,the incidence of the digestive system diseases was also very high, which took the first place in the War of Resistance Against Japanese Aggression and in the National War of Liberation, and took the second place in the War of Resistance Against American Aggression and Aid Korea and in Sino-Vitnamese War.In recent years, relevant investigations and studies have shown that the incidence of digestive system diseases of soldiers is still quite high in all medical diseases, of which, functional bowel disease and gastrointestinal ulcer are more common during the training period, and the risk of functional bowel disease may increase with the extension of military service time[4-5].The digestive system is closely related to the nervous system and is sensitive to changes of the external environment. Due to living in a relatively closed and depressing space, and receiving intense physical training,the army servicemen often have great psychological pressure.Therefore, army servicemen are prone to digestive diseases,which can further aggravate their psychological burden, reduce the quality of life, and even seriously affect combat capacity. As we know,the study on the spectrum of soldiers’ digestive system diseases is quite rare. So the purpose of our study is to investigate and analyze the spectrum of army servicemen’s digestive system diseases and find out relevant disease prevention and treatment strategies, so as to protect the health of servicemen and reduce non-combat personnel loss.
This study randomly selected 7 basic units of the army which had a field training in the midland of China and collected data related to the digestive system symptoms and diseases of 3,055 servicemen. It was found that 896 people had symptoms of the digestive system during the training period, with an incidence of 29.3%, and the diarrhea was the most common symptom, with an incidence of 13.7%. A total of 507 servicemen had gastrointestinal diseases, with a prevalence rate of 16.6%, among which, gastritis, enteritis, gastrointestinal ulcers and functional bowel diseases were more common. It is worth mentioning that the incidence of gastroenteritis for servicemen exceeded 15%, which was much higher than that of other diseases, and the result was similar to the finding of previous researchers[6-7]. As is known to all, vomiting, poor appetite, diarrhea, abdominal pain,and abdominal distension,were common clinical manifestations of gastroenteritis, which was consistent with our research. Therefore, we have to take measures to decrease the occurrence of gastroenteritis, gastrointestinal ulcer and functional bowel disease during a field training, which include not only hygienic diet and healthy living habits, but also the prevention and treatment of helicobacter pylori (Hp) infection. Hp can destroy the gastric and duodenal mucosal barrier by the self-colonization and secretion of toxins and toxic enzymes. So the standard anti-Hp treatment for patients can effectively reduce the occurrence and recurrence of gastritis and gastrointestinal ulcer. During the field training, the army servicemen have intense physical training in the tough environment, because the regions in the midland such as Hubei and Shaanxi Province are rainy, humid and very hot. And long-term high temperature and high pressure working environment increase the risk for functional bowel disease. Moreover, the army servicemen often have inadequate sleep time, which also increase the occurrence of functional bowel disease. Hence, for servicemen who always have training tasks every year, it’s quite necessary to receive regular blood test and abdominal ultrasound examination. To detect abnormal indicators early, and then adjust the diet structure timely, have a appropriate rest, and accept early intervention and treatment can prevent the progress of liver and gallbladder diseases.
In this study, we focused on the comparison of the digestive system symptoms and diseases for military officers and soldiers in different groups, and then found out there were significant differences in the incidence of digestive symptoms and diseases of servicemen among different groups of age, military service time, status, smoking amount,digestive disease family history,the field training time, irregular diet times,training pressure,chilled abdomen,defiled food history and disease prevention knowledge education(P＜0.01).but through regression analysis of statistically significant indicators in univariate analysis, we could know long military service time, officer status, long time of a field training, chilled abdomen, high training pressure and defiled food history had close relations with the occurrence of digestive system diseases.So these factors may be the risk factors of digestive diseases. In the army, veterans and military officers need to carry out more important tasks and more responsibility, that may explain the long service time and identity of military officer are closely related with the occurrence of digestive diseases. And some researchers also discover long time of service is the risk factor for functional bowel disease[10-11]. A study of the US Army also confirms that the prevalence of functional bowel disorder for soldiers is related to stressors, the service years is one of which. However, the investigation results in the basic units of the air force shows that the risk of functional bowel disease peaks at the age of 18-25 and over 41, which is quite different from the onset age of army as we discuss before[13-14]. This seems to suggest that there are differences in the characteristics of the disease among different services, which still needs further verification.The lectures on prevention and treatment knowledge can strengthen awareness of servicemen for digestive diseases, understand the characteristics, inducements and simple diagnosis and treatment rules of diseases. Our study also confirmed this view, the publicity of prevention and treatment knowledge once or twice a year can reduce the incidence of digestive diseases.
Non-steroidal drugs inhibit the synthesis of prostaglandin by inhibiting coxidase, which leads to the disruption of gastrointestinal mucosal balance and causes mucosal inflammatory lesions. Therefore, the long-term use of non-steroidal drugs is a risk factor for the occurrence of digestive system diseases. But in our study, there was no significant difference in the incidence of digestive symptoms and diseases between different groups of NSAIDs use history(P＞0.05)。Maybe it is associated with shorter duration of non-steroidal drug use, and after all, the time of a field training is generally not more than half a year.Also it may be related with the sample size, because the number of military personnel taking non-steroidal drugs is relatively less. Some studies believe that there is no clear relationship between smoking and the occurrence of digestive system diseases such as functional bowel disease [14-15]. The study also found that smoking did not increase the risk of digestive diseases by regression analysis. However, other studies have confirmed that large smoking amount is a risk factor for digestive system diseases[11，15]. So the relation remains to be confirmed by large-scale epidemiological studies.
In addition to focusing on the possible risk factors discussed in this study, the training on skills for military doctors such as online teaching and technical guidance from medical experts, is also very important for the prevention and treatment of digestive system diseases. Expanding the number coverage of gastroscopy, accelerating the development of 5G network application in endoscopy and the promotion of portable endoscopy will also help improve the professional level of medical personnel in the health center and the diagnosis and treatment rate of diseases.
As a regression investigation, this study cannot clearly determine the causal relationship between digestive system symptoms and diseases. Besides, digestive system symptoms and diseases in the questionnaire are mainly from servicemen’s clinic experience,not from doctors’ real-time diagnoses, which may be not reliable,and then lead to the biased investigation. So the next step is to follow up servicemen and conduct a large-scale prospective investigation and study.