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Area of Science:

  • Sports Medicine
  • Gastroenterology
  • Exercise Physiology

Background:

  • Gastrointestinal bleeding (GIB) in athletes is a recognized cause of underperformance.
  • It is often occult and self-limiting, contributing to underreporting.
  • GIB can stem from upper or lower GI sources and correlates with exercise intensity and duration.

Purpose of the Study:

  • To review the causes, pathophysiology, and management of gastrointestinal bleeding in athletes.
  • To highlight the importance of considering GIB in underperforming athletes.
  • To emphasize differential diagnosis and appropriate investigation.

Main Methods:

  • Review of existing literature on GIB in athletes.
  • Discussion of pathophysiological mechanisms including splanchnic hypoperfusion, mechanical trauma, and NSAID use.
  • Exploration of potential therapeutic and prophylactic strategies.

Main Results:

  • Key factors contributing to GIB include reduced blood flow to the GI tract during exercise, physical stress on the GI lining, and NSAID use.
  • Nutritional strategies, hydration, exercise regulation, and specific supplements like arginine and citrulline may alleviate GI symptoms.
  • Cessation of NSAIDs, acid-suppressing medications (PPIs, H2-antagonists), and gut adaptation strategies can reduce GIB incidence.

Conclusions:

  • Maintaining hemodynamic stability and identifying the bleeding source are crucial for managing GIB in athletes.
  • Endoscopy is a key diagnostic tool for both identifying the source and ruling out other pathologies.
  • GIB should not be automatically attributed to exercise; thorough endoscopic evaluation is essential to exclude other underlying conditions.