Exercise-associated intestinal ischemia

Ischemic bowel disease exhibits a complex spectrum of clinical presentations and in the athlete the disease may be superimposed on dehydration, hyperthermia, and exhaustion. Physicians caring for athletes should be aware of the manifestations of ischemic bowel disease and the optimum methods of diagnosis and treatment. Abdominal pain and diarrhea are typical initial symptoms of ischemia and these symptoms generally limit further damage. However, symptoms may be overridden in cases of extreme athletic competition or other significant endurance events such as combat. Athletes and coaches should be aware of the danger of ischemic bowel disease. Patients or athletes with recurrent symptoms of abdominal pain and diarrhea during exercise may be at increased risk for ischemic damage. However, no underlying anatomic abnormalities have been noted. Ischemic hemorrhagic gastritis is generally reversible and may be controlled with effective acid blockade. Ischemic colitis generally presents with pain, diarrhea, and bleeding. It is usually mild but may require volume and transfusion support, rarely progressing to need for resection or stricture. Severe presentations with intestinal infarction are rare but potentially life threatening. The athlete is usually able to ultimately resume his or her activities without restriction.