Abdominal symptoms during physical exercise and the role of gastrointestinal ischaemia: a study in 12 symptomatic athletes

Br J Sports Med. 2012 Oct;46(13):931-5. doi: 10.1136/bjsports-2011-090277. Epub 2011 Oct 20.


Background: Gastrointestinal (GI) symptoms during exercise may be caused by GI ischaemia. The authors report their experience with the diagnostic protocol and management of athletes with symptomatic exercise-induced GI ischaemia. The value of prolonged exercise tonometry in the diagnostic protocol of these patients was evaluated.

Methods: Patients referred for GI symptoms during physical exercise underwent a standardised diagnostic protocol, including prolonged exercise tonometry. Indicators of GI ischaemia, as measured by tonometry, were related to the presence of symptoms during the exercise test (S+ and S- tests) and exercise intensity.

Results: 12 athletes were specifically referred for GI symptoms during exercise (five males and seven females; median age 29 years (range 15-46 years)). Type of sport was cycling, long-distance running and triathlon. Median duration of symptoms was 32 months (range 7-240 months). Splanchnic artery stenosis was found in one athlete. GI ischaemia was found in six athletes during submaximal exercise. All athletes had gastric and jejunal ischaemia during maximum intensity exercise. No significant difference was found in gastric and jejunal Pco(2) or gradients between S+ and S- tests during any phase of the exercise protocol. In S+ tests, but not in S- tests, a significant correlation between lactate and gastric gradient was found. In S+ tests, the regression coefficients of gradients were higher than those in S- tests. Treatment advice aimed at limiting GI ischaemia were successful in reducing complaints in the majority of the athletes.

Conclusion: GI ischaemia was present in all athletes during maximum intensity exercise and in 50% during submaximal exercise. Athletes with GI symptoms had higher gastric gradients per mmol/l increase in lactate, suggesting an increased susceptibility for the development of ischaemia during exercise. Treatment advice aimed at limiting GI ischaemia helped the majority of the referred athletes to reduce their complaints. Our results suggest an important role for GI ischaemia in the pathophysiology of their complaints.

MeSH terms

  • Adolescent
  • Adult
  • Bicycling / physiology
  • Exercise / physiology*
  • Female
  • Gastrointestinal Diseases / blood
  • Gastrointestinal Diseases / etiology*
  • Gastrointestinal Diseases / physiopathology
  • Humans
  • Ischemia / blood
  • Ischemia / etiology*
  • Ischemia / physiopathology
  • Jejunum / blood supply*
  • Lactates / metabolism
  • Male
  • Manometry
  • Middle Aged
  • Running / physiology
  • Splanchnic Circulation / physiology
  • Stomach / blood supply*
  • Swimming / physiology
  • Young Adult


  • Lactates