Can exposure to Perchloroethylene (PCE), Trichloroethylene (TCE), Vinyl Chloride, and Benzene from Camp Lejeune water contamination cause Gastroesophageal Reflux Disease (GERD)?

Camp Lejeune Water Contamination and GERD: Examining the Connection

There is no established causal relationship between exposure to Camp Lejeune water contaminants (PCE, TCE, vinyl chloride, and benzene) and the development of gastroesophageal reflux disease (GERD). The available medical evidence does not support a direct link between these chemical exposures and GERD pathology.

Understanding GERD and Its Established Causes

GERD is a multifactorial condition characterized by the abnormal reflux of gastric contents into the esophagus, leading to symptoms and potential mucosal damage. According to gastroenterology guidelines, GERD pathogenesis involves:

• Recurrent exposure of the esophageal mucosa to acidic and non-acidic refluxate 1
• Complex immune-mediated inflammatory responses in the esophageal mucosa
• Functional and structural abnormalities of the gastroesophageal junction

The American Gastroenterological Association's position statement on GERD management does not identify environmental chemical exposures as primary risk factors for GERD development 2.

Camp Lejeune Water Contaminants: Known Health Effects

The European Association for the Study of the Liver's clinical practice guidelines on occupational liver diseases provide detailed information about the health effects of the chemicals found in Camp Lejeune water:

1. Trichloroethylene (TCE):

   • Associated primarily with liver and kidney damage
   • Can induce liver/kidney tumors in animal studies at high doses
   • No documented connection to gastrointestinal disorders like GERD 2

2. Perchloroethylene (PCE):

   • Primarily linked to potential liver effects
   • Studies have shown associations with esophageal cancer in some occupational settings, but not with GERD 3
   • No established causative relationship with inflammatory conditions of the esophagus 2

3. Vinyl Chloride:

   • Strong association with angiosarcoma of the liver
   • Can cause hepatic damage including fibrosis and cirrhosis
   • No documented connection to GERD in medical literature 2

4. Benzene:

   • Known hematologic toxin
   • No established connection to gastrointestinal inflammatory conditions like GERD 2

Pathophysiological Considerations

While these chemicals can cause various systemic health effects, the pathophysiological mechanisms of GERD are primarily related to:

• Transient lower esophageal sphincter relaxations
• Reduced esophageal clearance
• Delayed gastric emptying
• Hiatal hernia
• Obesity and dietary factors

None of the established mechanisms for GERD development have been linked to the specific chemical exposures from Camp Lejeune water contamination in the medical literature.

Risk Factors for GERD

The ACCP evidence-based clinical practice guidelines for chronic cough due to GERD identify several risk factors for GERD development, including:

• Medications (alendronate, corticosteroids, bronchodilators, calcium channel blockers)
• Obesity
• Smoking
• Alcohol consumption
• Dietary factors (fatty foods, chocolate, citrus)
• Certain respiratory diseases 2

Environmental chemical exposures like those at Camp Lejeune are not included among these established risk factors.

Clinical Implications

For patients with a history of Camp Lejeune water exposure who develop GERD:

• Standard GERD evaluation and management protocols should be followed
• Treatment should focus on established therapies including lifestyle modifications, acid suppression, and in some cases, surgical intervention 2
• Other potential health effects from the Camp Lejeune exposures should be monitored according to appropriate guidelines

Conclusion

While the chemicals in Camp Lejeune water (PCE, TCE, vinyl chloride, and benzene) have been associated with various health problems, particularly liver and kidney diseases and certain cancers, there is no established scientific evidence linking these exposures to the development of GERD. Patients with concerns about Camp Lejeune water exposure should receive appropriate screening for the known health effects of these chemicals, while GERD should be managed according to standard gastroenterological guidelines.