The role of gastrointestinal endoscopy in long-distance runners with gastrointestinal symptoms

Background Exercise-related gastrointestinal symptoms are not uncommon amon g athletes. The occurrence of gastrointestinal bleeding has been reported, especially in long-distance runners. We studied gastrointestinal mucosal da mage, using gastrointestinal endoscopy, in competitive long-distance runner s. Gastrointestinal blood loss and anaemia before and after running were al so assessed. Methods Sixteen competitive long-distance runners (all men; age range 16-19 years) participated in the study. All runners completed a symptom question naire prior to a 20 km race. Stool occult blood and haematological studies (haemoglobin, haematocrit, serum iron, total iron-binding capacity [TIBC] a nd ferritin) were performed before and immediately after the race. Gastroin testinal endoscopy was performed to assess macroscopic changes. Colonoscopy was also performed on the patients who had positive stool occult blood bef ore or after the race. Results Gastrointestinal symptoms were frequently experienced by the runner s. Gastritis (n = 16), oesophagitis (n = 6) and gastric ulcer (n = 1) were found at gastroscopy. Colonoscopy was performed on four patients who had po sitive stool occult blood. One had multiple erosions at the splenic flexure and one had a rectal polyp. Five runners had anaemia, and all of these had at least one endoscopic lesion (three gastritis, two oesophagitis and one multiple erosion at the splenic flexure). There were significant changes in the following haematological parameters after the race: iron (decreased, P = 0.02), ferritin (decreased, P = 0.001) and TIBC (increased, P = 0.00005) . Conclusions Gastrointestinal symptoms and gastrointestinal mucosal damage a re prevalent among long-distance runners. Prior to treatment, gastrointesti nal endoscopy should be considered in long-distance runners with gastrointe stinal symptoms and/or anaemia. (C) 2001 Lippincott Williams & Wilkins.