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chronic diarrhea in people who never before had that problem, or malignancy can be responsible for a change in bowel habits.

Therapy for irritable bowel depends on symptoms and other contributing factors. If the problem is due to lactose intolerance, one ceases to ingest lactose-containing products. Antimuscarinic agents are used to reduce spasm. Small doses of antidepressants are used for patients who have abdominal pain that one cannot characterize; antidiarrheal agents are used for those with diarrhea. It may be that in some cases the physician will recommend hypnotism or psychotherapy, depending on his or her concept of the cause.

GULF WAR VETERANS IN THE UNITED KINGDOM

Col. John Graham, M.D., spoke about the British experience with the Gulf War. The British government deployed about 50,000 troops. During deployment, health concerns focused on infectious, communicable, and diarrheal diseases as well as battle casualties. There was also a great deal of concern about the possible use of chemical and biological warfare agents.

Dr. Graham reported that veterans' health concerns in the United Kingdom following the Gulf War could be divided into two time frames: before a 1993 British Broadcasting program about illnesses in U.S. Gulf War veterans, and after. Before the program, concerns in the U.K. focused on health effects of exposure to smoke from burning oil wells and to depleted uranium and on treatment for posttraumatic stress disorder (PTSD). Following the program, veterans' concerns coalesced into what became known as Gulf War illnesses and underfinancing of the medical assessment program.

About 3000 veterans have been referred to the British medical assessment program. Symptoms reported are very similar to those reported by U.S. Gulf War veterans. British soldiers do, however, have a higher rate of diagnosed PTSD than that reported in the United States. A research program was commissioned to determine if there was an excess of ill health in the veteran community, to find if such ill health could be related to exposures in the Gulf, and to come up with treatment and preventive strategies. A study by Simon Wessley found that British Gulf veterans report the same kinds of symptoms that British Bosnian veterans do but at two to three times the rate. Nicholette Cherry's study of mortality did not find any statistically significant differences between the Gulf veteran cohort and the Erie group (veterans deployed to Northern Ireland), although there was a slight excess in the number of deaths due to external causes (e.g., automobile accidents) in the Gulf veteran group. These findings mirror the findings of Han Kang's study in the United States.

Simon Wessley has conducted a second-phase study where ill veterans and ill controls are brought in for clinical evaluation. Dr. Wessley



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