Dietary habits, nutrition knowledge, and gastrointestinal complaints were evaluated in 21 female and 50 male triathletes; 30 completed hemoccult slides to determine the frequency of gastrointestinal bleeding. Triathletes trained 11 h/wk with weekly distances of 5.3, 116.5, and 40.9 km for swimming, biking, and running, respectively. Mean daily energy intake averaged 9058 and 11,591 kJ for women and men, respectively; 53.8% of the energy was from carbohydrates. Mean intakes of vitamins and most minerals exceeded the Recommended Dietary Allowances (RDAs), but many had intakes below RDAs for some nutrients; greater than 60% had low zinc and copper intakes. Because 39% took a daily multivitamin-mineral supplement, some had intakes 200-600% above the RDA. Although there were notable misconceptions about nutrition, nutrition knowledge was high. Upper-gastrointestinal complaints, reported by 50%, included bloating and abdominal gas; the incidence of positive hemoccult slides was 27%. The relation among performance, dietary patterns, nutrition knowledge, and gastrointestinal function remains to be established.

Surveys of athletes, primarily runners, have shown that digestive disorders are common, associated both with training and racing. Women, in particular, seem to suffer most commonly. Nearly half have loose stools and nausea and vomiting occur frequently after hard runs. Diarrhoea, incontinence and rectal bleeding occur with surprising frequency. Runners may use medications prophylactically to minimise some of these symptoms. Upper digestive symptoms seem to occur more commonly in multisport events such as triathlons or enduro. The published literature is difficult to analyse and the basic intestinal physiology not well studied. Most gastroenterologists are accustomed to evaluating the fasting patient at rest and exercise physiologists are seldom experienced with digestive techniques. Digestive symptoms occurring with exercise referable to the oesophagus include chest pain, gastro-oesophageal reflux symptoms, or symptoms related to alterations in motility. While little is known of the oesophageal physiology during exercise, it is believed that only minimal changes occur in most subjects. Gastro-oesophageal reflux occurs more frequently with exercise than at rest and may produce symptoms of chest pain suggestive of ischaemic disease. Acid exposure may be reduced by pretreatment with histamine H2-receptor antagonists. Oesophageal symptoms, though common, are rarely disabling to the athlete, and the clinical importance lies in confusion with ischaemic disease. Cases of acute gastric stasis following running have been reported and gastric physiology during exercise, particularly bicycling, has been more actively investigated. Gastric emptying during exercise is subject to a number of factors including calorie count, meal osmolality, meal temperature and exercise conditions. However, it is generally accepted that light exercise accelerates liquid emptying, vigorous exercise delays solid emptying and has little effect upon liquid emptying until near exhaustion. Gastric acid secretion probably changes little with exercise although some have postulated that ulcer patients may increase secretion with exercise. Some exercise-associated digestive symptoms, such as diarrhoea and abdominal pain, have been attributed to changes in intestine function. Small bowel transit is delayed by exercise when measured by breath hydrogen oral caecal transit times and motility may be reduced as well. Intestinal absorption during exercise has not been well evaluated but probably changes little in ordinary circumstances. Passive absorption of water, electrolytes and xylose are not affected by submaximal effort. Colonic transit and function is even more difficult to evaluate and published results have been conflicting. However, it is likely that many of the lower digestive complaints of runners such as diarrhoea and lower abdominal cramps are due to direct effects of exercise upon the colon.(ABSTRACT TRUNCATED AT 250 WORDS)

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A prospective study was undertaken to determine the frequency of detectable gastrointestinal bleeding in participants of a 100-mile running race. Pre- and postrace questionnaires were utilized to determine training data, gastrointestinal symptoms, diet, and the use of medications during training and during the race, prior known gastrointestinal disease, and 100-mile race experience. Three prerace and the first three postrace stools were sampled for blood using the standard Hemoccult method in 35 runners: 85% of the participants who were Hemoccult negative before the race converted to positive in their postrace samples. Runners with the postrace Hemoccult-positive stools had more frequent and intense nausea, diarrhea, abdominal cramping, and bloating (P less than 0.05) during the race. Lower gastrointestinal symptoms correlated with Hemoccult positivity (P less than 0.05), whereas upper gastrointestinal symptoms did not. The majority of participants showed evidence of gastrointestinal bleeding after the race. Digestive symptoms are common and lower gastrointestinal symptoms correlate with gastrointestinal bleeding.

The use of environmental endoscope culturing is a rapid, simple, inexpensive method to monitor effectiveness of standard reprocessing procedures. Disinfection is less effective with poor mechanical cleansing, and high-titer positivity is a marker for poor cleaning technique. Standard upper and lower scopes are commonly culture negative. Duodenoscopes, because of their inherent complexity, and other scopes used in emergent conditions require particular attention. Surveillance culture results can be used to identify patterns of poor technique, to reinforce proper procedure, and to modify clinical practice. No associated clinical illness was apparent during this study.