Strenuous exercise may result in significant gastrointestinal symptoms. These may be severe enough to cause the athlete to discontinue the event.
Symptoms may include:
(1) reflux disease
(2) bloating
(3) belching
(4) epigastric or abdominal pain
(5) vomiting
(6) diarrhea or loose stools
(7) gastrointestinal bleeding
(8) flatulence
(9) colitis-like symptoms
(10) malabsorption
Risk factors for occurrence:
(1) prolonged exercise, especially an endurance sport
(2) high intensity
(3) heat stress
(4) NSAIDS
(5) lack of acclimatization
(6) dehydration or overhydration
(7) diet, especially overeating during exercise
(8) history of exercise-associated gastrointestinal symptoms
Proposed mechanisms:
(1) altered motility (delayed gastric emptying, change in intestinal transit times)
(2) damage to mucosa, including ischemia
(3) endotoxemia
Differential diagnosis:
(1) food poisoning
(2) other infection
(3) inflammatory bowel disease
(4) other gastrointestinal disorder
