gi symptoms most often reported include gastroesophageal (GE) reflux, abdominal pain, diarrhea, and nausea.

Incidence greater than 80% in certain groups of running athletes.

Rowers, cross-country skiers, swimmers and cyclists, report similar problems.

Runners have a higher incidence of lower gi symptoms vs upper gi symptoms (71% vs 36% respectively).

Cyclists had a fairly even split between upper and lower gi symptoms (67% vs 64% respectively).

Transient relaxation of the lower esophageal sphincter (LES) due to air swallowing, alcohol, caffeine, high-fat foods, smoking, and many drugs.

Increase in acid production has been suggested; however, recent studies indicate that decreased gastric mucosal secretion, resulting from reduced splanchnic blood flow, is more likely.

Accentuated by NSAID use, emotional stress, or any factor that increases acid production.

Delayed gastric emptying, seen w strenuous exercise, may also contribute.

Helicobacter pylori infection should be considered in cases of chronic or recurrent upper gi symptoms.

Common upper gi symptoms include belching, nausea, vomiting, and epigastric pain.

Usually experienced during maximal exertion.

May mimic symptoms of cardiac disease.

Symptoms are generally worse w increasing intensity or prolonged duration of exercise and are more severe with immediate postprandial exercise (within 3 hr of eating).

Documentation of training habits, NSAID use, diet, and prior history (or family history) of gastritis, peptic ulcer disease, inflammatory bowel disease, or other gi problems important.

Complete blood cell count to assess hemoglobin and hematocrit to ensure that there is no significant blood loss.

Liver function testing with transaminases, bilirubin, and amylase are relatively inexpensive and will help to exclude other causes of upper gi symptoms such as hepatitis, pancreatitis, and biliary tract disease.

Serologic testing for H. pylori is now available and is indicated in the runner with chronic dyspepsia.

An electrocardiogram (EKG) or electrocardiographic stress test should be obtained in athletes presenting with epigastric pain and associated cardiac risk factors (> 40 y/o, smoking history,
family history, hyperlipidemia or comorbid disease state) or if associated symptoms suggest cardiac origin (shortness of breath, diaphoresis, radiating pain).

Endoscopy (EGD) should be performed in pts w recurrent or persistent symptoms in the face of treatment.

Ambulatory pH monitoring and LES manometry is considered w refractory symptoms following an otherwise normal evaluation.

Most often, simple changes in diet, meal timing, and training habits will alleviate these symptoms.

Athletes may also reduce these symptoms by temporarily decreasing training or by alternating running with a lower-impact workout, eg, cycling or swimming.

Medical therapy options include: