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Exercise-related gastrointestinal disorders

Authors
John H Kwon, MD, PhD
J Thomas Lamont, MD
Section Editor
Lawrence S Friedman, MD
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

INTRODUCTION

Exercise-related gastrointestinal symptoms can impact performance. Many of these symptoms are related to physiologic changes resulting from exercise [1,2]. Physiologic changes include alterations in enteric nervous system activity, circulating gut hormone levels, intestinal blood flow, nutrient and electrolyte absorption, intestinal secretion, and motility [1]. This topic review will discuss the most frequently observed gastrointestinal disorders that occur in athletes.

EPIDEMIOLOGY AND RISK FACTORS

The incidence of exercise-induced gastrointestinal (GI) symptoms range from 20 to 96 percent [3-10]. The incidence is higher in women and in younger athletes [2,3]. Exercise-related gastrointestinal symptoms are frequently associated with consumption of a meal within two to three hours of exercising [3,5,11-14]. Dehydration and analgesic use are associated with a higher incidence of GI symptoms [15,16]. While some studies have found an association between the intensity of the exercise and the incidence of GI symptoms, results have been inconsistent [3,5,12,13,17,18].

GI symptoms vary with the type of exercise. In general, long-distance runners have a high incidence of lower GI symptoms (eg, fecal urgency, diarrhea, rectal bleeding), and transient abdominal pain. Cyclists have a high incidence of upper GI symptoms (eg, regurgitation, heartburn, nausea, and vomiting) [3,5,12,14,19]. Nausea is the most frequently reported symptom in ultramarathon runners [9,20,21].

ABDOMINAL PAIN

Exercise-related transient abdominal pain — Exercise-related transient abdominal pain (ETAP) (side-stitch, stitch, or sub-costal pain) is a frequent cause of mild abdominal pain in athletes.

Incidence — The incidence of ETAP ranges from 6 to 68 percent [3-5,12,13,22,23]. ETAP occurs most frequently during long-distance running but has also been associated with other sports [22]. The incidence is higher in younger individuals and following recent ingestion of food and hypertonic fluids.

         

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Literature review current through: Jul 2017. | This topic last updated: Jul 25, 2017.
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