Gastroesophageal Reflux in Athletes

Abstract

Gastroesophageal reflux (GER) and its associated symptoms are common among athletes. In the athlete, GER increases with intensity of exercise, is more common with endurance sports, and worse with postprandial exercise. GER has symptoms that overlap with other upper gastrointestinal (GI) conditions. Symptoms of GER can be difficult to distinguish from cardiac chest pain. GER may exacerbate asthma. Proposed mechanisms causing GER during exertion include altered GI blood flow and motor function, neuroendocrine changes, and mechanical effects. GER symptoms that interfere with activity may respond to lifestyle modification or pharmacologic therapy.

Lifestyle Factors and Risk for Symptomatic Gastroesophageal Reflux in Monozygotic Twins

“…[15][16][17][18][19][23][24][25] Physical exercise may provoke gastroesophageal reflux (GER) symptoms via a mechanism of increased esophageal acid exposure during exercise, 26 and GER symptoms are common among athletes. 27 In previous epidemiological studies of relatively small sample sizes, physical exercise was 28 or was not 29 associated with an increased frequency of GER. However, in one large population-based study from our group, we found that physical exercise renders a protective effect against GERD.…”

Asthma, outdoor air quality and the Olympic Games

“…Comorbid conditions frequently observed in athletes, such as rhinitis, vocal cord dysfunction or gastroesophageal reflux, may affect asthma control or act as confounders, and investigation and treatment is necessary. 41,42 Education is an essential component of asthma management, especially among athletes. 43 Environmental control and avoidance of triggers are also important for Olympic athletes.…”

Running, esophageal acid reflux, and atrial fibrillation: A chain of events linked by evidence from separate medical literatures

“…Several reviewers have, however, cited surveys reporting that, in larger populations of endurance athletes (in one case, a survey of 606 well-trained sportsmen), on the order of 36% to 67% have complained of upper GI symptoms chararacteristic of GER (15,16).…”

“…A variety of reflux mechanisms have been suggested or investigated, including reduced gastric motility and absorption, decreased esophageal acid clearance, reduced or disorganized peristaltic esophageal motility, lower-esophageal sphincter relaxation, and reduced GI blood flow (15). Susceptibility to exercise induced GER may depend strongly on the structural integrity of the esophogastric junction (particularly the flap valve) (17).…”

“…Proton pump inhibitors (PPIs) are widely reported as beneficial in the treatment of exerciseinduced GER (15,16,18).…”