Exploring the gut-exercise link: A systematic review of gastrointestinal disorders in physical activity

Table 8 Studies related to exercise-induced gastrointestinal bleeding

Ref.	Type of article	Age of patients included	Summary of study characteristics	Outcome
Papantoniou et al[9]	Review	Not specified	Explored GI bleeding in athletes, linking it to splanchnic hypoperfusion, NSAIDs, and mechanical trauma. Discussed nutrition, hydration, and medication as preventive measures. Endoscopy highlighted for diagnosis	GI bleeding in athletes is often self-limited but can impact performance. Prevention includes gut training and reducing NSAIDs use
Zaffar et al[82]	Case report	21-year-old male	Ischemic colitis in a soccer player following vigorous physical activity. Diagnosed via colonoscopy showing ischemic changes	Symptoms resolved with supportive care and hydration
Moses[165]	Review	Not specified	Examined visceral ischemia-mediated GI bleeding during prolonged exercise. Highlighted hemorrhagic gastritis and colitis as common lesions	GI bleeding is usually transient and reversible. Cimetidine showed potential for recurrent cases, but most therapies are unclear
Baska et al[166]	Prospective Study	Not specified	Assessed GI bleeding during a 100-mile ultramarathon using stool tests. 85% showed occult blood post-race. Symptoms included nausea and diarrhea	Exercise-related lower GI bleeding linked to physical stress, with symptoms correlated to fecal blood positivity
Rodríguez de Santiago et al[167]	Case report	30-year-old male	A cyclist with intense training presented with melena due to gastric ulcers caused by vigorous exercise. Diagnosed via endoscopy and treated with proton pump inhibitors	Exercise-induced gastric ulcers resolved with medication and moderated physical activity
Schaub et al[168]	Case report	33-year-old male	Reported ischemic colitis in a marathon runner with post-race bloody diarrhea. A colonoscopy showed ischemic mucosal lesions	Ischemic colitis is caused by reduced intestinal blood supply during intense exercise
Cooper et al[169]	Case report	33-year-old female	Described erosive gastritis and GI bleeding in a runner. Blood loss confirmed by 51Cr-labeled red cells. Symptoms resolved with cessation of exercise and H2-receptor antagonist therapy	Exercise-induced gastritis and bleeding are reversible with treatment or reduced activity
Halvorsen et al[171]	Prospective study	Not specified	Studied marathon runners for fecal occult blood. 13% tested positive post-race, with no overt bleeding or anemia	GI bleeding is common but asymptomatic in marathoners
McCabe et al[172]	Prospective study	Not specified	Evaluated 125 marathon runners for GI bleeding using stool occult blood tests. 23% converted to positive post-race	GI bleeding correlated with long-distance running
Choi et al[173]	Prospective study	16-19 years	Investigated GI mucosal damage in long-distance runners via endoscopy. Found gastritis in all, esophagitis in 6, and gastric ulcers in 1 participant	GI mucosal damage is prevalent in competitive runners

GI: Gastrointestinal; NSAIDs: Non-steroidal anti-inflammatory drugs; H2: Histamine-2; 51Cr: Chromium-51.