moderate amounts of exercise were associated
with altered lower oesophageal sphincter pres-
sure, which was measured using a small
manometer placed at the gastro-oesophageal
junction. Other studies link symptoms of dis-
ordered oesophageal motility to factors which
include exercise intensity, the timing of food
intake, specific foods such as alcohol and coffee
and the influence of smoking (Schoeman et al.
1995). However, the latter is an unlikely habitual
associate of the athlete.
Measures which reduce the volume of the
stomach contents during exercise are likely to
reduce the possibility of symptoms associated
with reflux. In the same way, the composition of
the prerace meal has been found to influence
symptoms such as flatulence and side ache.
Peterset al. (1993) tested different carbohydrate
supplements in 32 male triathletes to determine
the prevalence, duration and seriousness of gas-
trointestinal symptoms. Their results suggested
possible mechanisms including duration of exer-
cise, altered gastrointestinal tract blood supply,
carbohydrate ‘spill over’ and the postural (verti-
cal) effect of running.
The symptomatic relief of ‘heartburn’ can be
achieved through the use of simple antacids such
as aluminium hydroxide, sodium bicarbonate,
magnesium carbonate or alignic acid. If such
agents alone are insufficient to relieve symptoms
then the use of H 2 -receptor antagonists is indi-
cated. Examples of these agents include cimeti-
dine and ranitidine. Their action is to inhibit both
the stimulated basal secretion of gastric acid
and to reduce pepsin output by histamine H 2 -
receptor antagonism. Additional therapy may
include the use of muscarinic M 1 -antagonists,
prostaglandin analogues or proton pump
inhibitors such as omeprazole. Metaclopramide
may also provide short-term relief by improving
the contractility of the lower oesophageal sphinc-
ter tone.
Reports of upper gastrointestinal tract bleed-
ing associated with physical exertion have been
well documented, and recently correlated with
digestive complaints and clinically demonstra-
ble iron-deficient states (Brouns 1991; Wright
1991; Moses 1993; Rudzkiet al.1995). The causes
of such blood losses can include a Mallory–Weiss
tear from the mechanical trauma of repetitive
vomiting to bleeding from a peptic ulcer. Any
unaccountable blood loss from the gastrointesti-
nal tract deserves full clinical investigation.Gastric symptoms
The commonly reported effects of gastric dys-
function in athletes include nausea, bloating,
epigastric pain and belching. In addition, haem-
orrhagic gastritis is reported as a common cause
of gastrointestinal tract bleeding but is most
often transient and usually localized to the
fundus (Brukner & Kahn 1993). The use of salicy-
lates and non-steroidal anti-inflammatory drugs
(NSAIDs) in the athletic population is also recog-
nized as having a potential for gastrointestinal
tract irritation leading to gastritis and ulceration.
However, in two studies the use of these drugs
was not correlated with an increase in upper
gastrointestinal tract bleeding (McMahon et al.
1984; Baska et al. 1990). An additional problem
with NSAID ingestion linked with their
antiprostaglandin effect is a reduction of renal
blood flow, which is considered to be a potential
factor in the genesis of renal failure in athletes
(Walker et al. 1994).
Documented influences upon the rate of
gastric emptying in athletes include the tempera-
ture, energy content and osmolality of the gastric
contents, environmental temperature and exer-
cise conditions (Costill & Saltin 1974; Murray
1987; Neufer 1989a; Moses 1990; Rehrer et al.
1990b; Green 1992). Hyperosmolar solutions
have been found to empty more slowly from the
stomach during exercise and therefore should be
avoided. While light exercise is considered a posi-
tive stimulus to the gastric emptying of fluids, the
passage of solid foods is delayed by vigorous
activity (Moses 1990). The clinical significance of
this information is the timing and composition of
precompetition meals, and advice for those ath-
letes whose choice of event demands that they
‘top up’ during a race or on long training runs.
Gastric retention has been suggested as causing