Article

The effect of different types of exercise on gastro-oesophageal reflux

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Abstract

Sportsmen and women frequently experience abdominal and chest pain during exertion. The symptoms could be cardiac but may be caused by gastro-oesophageal reflux (GOR). The aim of our study was to investigate the effect of the two activities on GOR in 17 fit, healthy adults. GOR, assessed by intraoesophageal pH, was recorded on portable monitoring equipment before, during and after rowing and running. GOR was also measured after a light meal to simulate pre-training hydration. Three studies were performed: rowing, fasted running, and post-prandial running. GOR was infrequent before exercise, being seen in only 2 subjects. However, GOR was induced in 70% of rowers, 45% of fasted runners, and 90 % of fed runners during and immediately after exercise. The presence of food in the stomach greatly increased the amount of reflux during post-prandial running, (p < 0.006 against control) but reflux was also significantly higher in those who refluxed during fasted running (p < 0.03) and rowing (p < 0.08). There was no statistical difference in the amount of GOR between the two exercise periods. This study shows that both running and rowing induce significant amounts of GOR in a normally asymptomatic group of athletes. GOR should be considered in the investigation of exertional chest pain in patients attending a sports clinic.

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... 2,3 Strenuous exercise may cause belching, abdominal fullness, regurgitation, heartburn, and chest pain in up to 45% to 90% of athletes. 4 However, different modes, duration, and frequency of exercise, as well as the individual training status, play an important role in exercise-induced symptom expression. ...
... All 3 forms of exercise were associated with significantly more reflux after meals compared with fasting. This observation was confirmed by Yazaki et al. 4 (evidence category B), who monitored reflux exposure in 17 well-trained athletes assigned to 3 exercise studies: rowing, fasted running, and postprandial running. All 3 types of exercise induced acid reflux that was increased significantly after a meal. ...
Article
Exercise is beneficial to health because it reduces the risk of cardiovascular and endocrine diseases, improves bone and muscle conditioning, and lessens anxiety and depression. However, the impact of exercise on the gastrointestinal system has been conflicting. This systematic literature review evaluates the effect of the different modes and intensity levels of exercise on gastrointestinal function and disease using an evidence-based approach. Although more applicable to trained athletes and individuals who are highly active and, as such, at risk to experience the side-effects of exercise, an effort was made to state the level or degree of exercise or the lack of such evidence. Light and moderate exercise is well tolerated and can benefit patients with inflammatory bowel disease and liver disease. Physical activity can also improve gastric emptying and lower the relative risk of colon cancer in most populations. Severe, exhaustive exercise, however, inhibits gastric emptying, interferes with gastrointestinal absorption, and causes many gastrointestinal symptoms, most notably gastrointestinal bleeding. This knowledge will enable physicians to prescribe physical exercise in health and disease and to better manage patients with exercise-related gastrointestinal disorders. Our understanding of exercise and its gastrointestinal manifestations as well as risks and benefits warrants further investigation.
... 7,24 -26 Physical activity also increases the degree of reflux. [27][28][29][30][31] It is possible, therefore, that patterns of acid and nonacid, or gas and liquid, reflux under ambulatory conditions might differ from those under stationary conditions. ...
... 7,24 -26 Physical activity also increases the degree of reflux. [27][28][29][30][31] A major reason for the increased rate of acid reflux episodes in patients with reflux disease seems to be that, when reflux occurs, the refluxate is more acidic. The factors that make the refluxate more acid in patients with reflux disease are not clear and were not investigated in this study. ...
Article
Gastroesophageal reflux can be acid, nonacid, pure liquid, or a mixture of gas and liquid. We investigated the prevalence of acid and nonacid reflux and the air-liquid composition of the refluxate in ambulant healthy subjects and patients with reflux disease (GERD). Twenty-four-hour ambulatory recordings were performed in 30 patients with symptomatic GERD and erosive esophagitis and in 28 controls. Esophageal pH and impedance were used to identify acid reflux (pH drop below 4.0), minor acid reflux (pH drop above 4.0), nonacid reflux (pH drop less than 1 unit + liquid reflux in impedance), and gas reflux. The total rate of gastroesophageal reflux episodes was similar in patients and controls. Patients with GERD had a higher proportion (45% vs. 33%) and rate of acid reflux than controls (21.5 [9-35]/24 h vs. 13 [6.5-21]/24 h; P < 0.05). One third of reflux events was nonacid in both groups. Mixed reflux of gas and liquid was the most frequent pattern with gas preceding liquid in 50%-80% of cases. Pure liquid reflux was more often acid in patients with GERD than controls (45% vs. 32%; P < 0.05). Reflux of gastric contents was similarly frequent in patients with GERD and controls. Although there was no difference in the overall number of reflux episodes, more acidic reflux occurred in symptomatic patients with GERD, suggesting differences in gastric acid secretion or distribution.
... Among 189 patients investigated for EIRS, TurzÍkovÁ et al. [21] identified 14 (7%) patients involved in sports activities with negative exercise challenge, no gastro-oesophageal symptoms, but with cough hand dyspnoea during exercise correlating with gastro-oesophageal reflux episodes, by pH monitoring. Exercise is a risk factor that can induce gastro-oesophageal reflux [23] through a low thoracic pressure during forced respiration, combined with an increased abdominal pressure during exercise. ...
... GASTROESOPHAGEAL REFLUX DISEASE Symptomatic reflux of gastric contents into the esophagus is encountered in approximately 60% of athletes and occurs more frequently during exercise than at rest [31,32]. Exercise not only exacerbates GERD, as demonstrated in studies that used ambulatory pH monitoring333435, but is also a contributing factor to reflux in healthy volunteers [32]. And although proton pump inhibitor therapy reduced acid reflux in runners, symptoms of heartburn, chest pain, and regurgitation were omnipresent, suggesting a multifactorial cause of GERD during exercise [36]. ...
Article
Gastrointestinal (GI) illnesses are common in athletes. Various causes include adverse physiologic adaptations of the gut during exercise; excess ingestion of carbohydrate drinks, alcohol, and anti-inflammatory medications; emotional stressors; exposure to pathogens in closed environments and during travel; trauma; and abdominal wall pressure overload. Unfortunately, evidence-based management of GI illnesses in athletes is limited because most studies have compared various GI illnesses between different sports, rather than comparing athletes to nonathletes. This article reviews the evidence that is available specifically relating to etiology, pathophysiology, clinical presentation, relevant differential diagnoses, acute management, and recommendations for specialist consultation of various GI illnesses in the training-room setting.
... The benefits of exercise on the gastrointestinal system are less defined. Although there is evidence that exercise provide benefits for patients with inflammatory bowel disease and can lower relative risk of colon cancer [75], it has been associated with increasing GERD-related symptoms such as heartburn, chest pain, or abdominal fullness in up to 45-90% of athletes [76]. ...
Article
Full-text available
Gastroesophageal reflux disease (GERD) is a common disease affecting a significant number of adults both globally and in the USA. GERD is clinically diagnosed based on patient-reported symptoms, and the gold standard for diagnosis is ambulatory reflux monitoring, a tool particularly utilized in the common scenario of non-response to therapy or atypical features. Over the past 20 years, there has been a shift toward extending the duration of reflux monitoring, initially from 24 to 48 h and more recently to 96 h, primarily based on a demonstrated increase in diagnostic yield. Further, multiple studies demonstrate clinically relevant variability in day-to-day acid exposure levels in nearly 30% of ambulatory reflux monitoring studies. For these reasons, an ongoing clinical dilemma relates to the optimal activities patients should engage in during prolonged reflux monitoring. Thus, the aims of this review are to detail what is known about variability in daily acid exposure, discuss factors that are known to influence this day-to-day variability (i.e., sleep patterns, dietary/eating habits, stress, exercise, and medications), and finally provide suggestions for patient education and general GERD management to reduce variation in esophageal acid exposure levels.
... Gastroesophageal reflux occurs more frequently with exercise than at rest [28] . Some GI symptoms occurring with exercise can be of esophageal origin, including chest pain and heartburn. ...
Article
To evaluate the effect of ranitidine on gastric mucosal changes and on GI bleeding in long distance runners. Twenty-four long distance runners (M: 16, F: 8, age: 18.2 +/- 1.5 years) participated in this study. A symptom questionnaire, stool hemoccult test, and upper gastrointestinal (GI) endoscopy were performed on the subjects prior to the study. The subjects took oral ranitidine (150 mg, b.i.d.) for two weeks. The upper GI endoscopy and stool Hemoccult tests were repeated after the treatment. Twenty-two of the 24 runners had at least one upper GI mucosal lesion before the medication. The Endoscopic improvements were seen in eleven of the 14 cases of erosive gastritis and four of the 5 cases of esophagitis. Six subjects were Heme occult positive prior to the study, but only one was positive after the medication. Gastric mucosal lesions and GI bleeding in long distance runners seem to be associated to acid-related factors mediated by the high level of regular running. Ranitidine seems to be and effective prophylaxis to prevent gastric mucosal lesions and GI bleeding.
... Coughing is a violent forced expiratory manoeuvre associated with rapid rises in pressure in both the thorax and abdomen and patients with chronic cough have high cough frequencies compared to other patient groups. Strenuous exercise is known to provoke reflux events [14][15][16] and it is conceivable that coughing may produce a similar effect. Possible mechanisms are breach of lower oesophageal sphincter and transient lower oesophageal sphincter relaxations (TLOSR) [17]. ...
Article
Gastro-oesophageal reflux disease (GORD) is generally considered one of the three main causes of chronic cough, along with asthma and nasal disease. The diagnosis of GORD is often based upon a successful trial of anti-acid treatment however GORD is a complex condition taking many forms. Only recently have studies started to address the different types of GORD in patients with chronic cough and how these may infer the mechanisms linking these common conditions. GORD can be assessed in a number of ways; whilst endoscopy provides evidence of oesophagitis (i.e. erosive disease), 24-h ambulatory oesophageal pH monitoring may demonstrate abnormal oesophageal acid exposure in the absence of oesophageal damage (i.e. non-erosive disease). The development of oesophageal impedance monitoring now allows the assessment of all reflux events (regardless of degree of acidity) and further classification of reflux by the proximal extension e.g. to upper oesophagus or even pharynx. Chronic cough patients may still be considered to have GORD if there is a significant temporal association between reflux events and coughing. Recent studies have examined the relationships between cough and reflux events, the roles of distal and proximal/pharyngeal reflux and also micro-aspiration in chronic cough patients. Increasing evidence suggests a significant proportion of patients display statistical associations between reflux and cough events, in the absence of an excessive numbers of reflux events either within or outside of the oesophagus.
... Similar results have been obtained in untrained subjects. More recently, these data have been replicated for other activities, although research in trained cyclists has suggested that the physical agitation and movement of the body may be more important than the exercise per se in producing these symptoms (75,76). There appears to be no correlation between gastroesophageal reflux and exercise-induced bronchoconstriction or asthma (77). ...
Article
Full-text available
A world-wide recognised and accepted definition and classification of gastroesophageal reflux disease (GERD) would be highly desirable for research and clinical practice. The purpose of this project was to develop such a generally accepted definition and classification that could be used equally by patients, physicians, and supervisory bodies. In order to ensure a consensus among the participating experts a modified delphi process with a step-wise selection modality was employed. For this the working group of five persons formulated a series of statements on the basis of a systematic search of the literature using three databases (Embase, Cochrane-Study register, Medline). Then these statements were developed further for two years, revised and finally passed as consensus. The consensus group consisted of 44 experts from 18 countries. Each key vote was held on the basis of a six-point scale. A "consensus" was considered to have been reached when two-thirds of the participants voted in favour of the respective statement. The level of agreement between the experts increased in the course of the multistep decision process, in the individual voting steps requiring at least two-thirds of the participants, the results were at first 86%, then 88% through to 94% and finally 100% in favour of the chosen statement. In the final voting, 94% of the final 51 statements were accepted by 90% of the consensus group. 90% of all statements were accepted unanimously or with only minor reservations. GERD was defined as a disease that is associated with troublesome symptoms and/or complications on account of reflux of stomach contents into the esophagus. The complaints are divided into esophageal and extra-esophageal syndromes. Among the novel aspects of this definition are the patient-orientated approach that is independent of endoscopic findings, the classification of the ailment into independent syndromes as well as the consideration of laryngitis, cough, asthma and dental problems as possible GERD syndromes. Furthermore, a new definition of suspected or demonstrated Barrett's esophagus is proposed. Irrespective of country-specific differences in terminology, language, prevalence and manifestations of this disease, evidence-based, world-wide valid consensus definitions are possible. A global consensus definition of GERD will simplify disease management, make mutual research possible and help in the design of generally valid studies. This will not only help the patient but also the physician and supervisory bodies.
... 3,9,[24][25][26] It has been noted that gastrooesophageal reflux may be associated with some forms of exercise. 27 The present study asked if respondents ever suffered regular regurgitation but did not specify the time, e.g., after extreme exercise. No statistically significant association between dental erosion and regurgitation or acidic taste in the mouth was noted. ...
Article
The consumption of acidic foods and drinks is increasing in popularity. The purposes of the present study were to investigate the consumption patterns of acidic foods and drinks among several sport groups and to examine any relationships between consumption patterns and dental erosion. A questionnaire of oral health habits, diet and dental health was developed. Thirty-two sports clubs (690 members) of the University of Melbourne participated in a survey. A total of 508 usable questionnaires were received (74.9 per cent response). Descriptive statistics were prepared and logistic regression was used to explore relationships between dental erosion (dependent variable) and the independent variables. Dental erosion was reported by 25.4 per cent of respondents, particularly among athletes of the Martial arts (affecting 37.4 per cent). The consumption of acidic foods and drinks was frequent among most athletes. No significant associations were identified between dental erosion and the frequency of drinking soft drinks or sports drinks. Statistically significant associations were found between dental erosion and age group (p=0.004), frequency of drinking juices (p=0.05), and tooth sensitivity (p=0.001). Athletes may be placing themselves unintentionally at risk of dental erosion and dentists could counsel athletes to control and reduce the effect of potentially erosive foods and drinks.
... Öksürük hem toraksta hem de abdomende ani basınç artışıyla birlikte şiddetli zorlamayla ortaya çıkan ekspiratuvar bir manevradır ve kronik öksürüğü olan olguların diğer olgulara oranla daha yüksek öksürük frekansları vardır. Yorucu egzersizlerin reflü ataklarını provoke edebildiği bilinmektedir [34][35][36] ve öksürük de benzer etkilere neden olabilir. Olası mekanizmalar alt özofagus sfinkterinin işlev kusuru ve geçici alt özofageal sfinkter relaksasyonlarıdır (TLESR) [37]. ...
Article
Full-text available
Gastroesophageal reflux disease (GERD) is common, but has varying prevalence around the world, with Western Europe, North America, South America, and Turkey having the highest prevalence rates of approximately 10% to 20%. Bor et al. reports 20% GERD prevalence in Turkey. Heartburn and regurgitation are common symptoms of typical reflux disease with the most common manifestation of esophageal injury being reflux esophagitis; how-ever manifestations of GERD include both esophageal and extraesophageal syndromes. Reflux cough syndrome, reflux laryngitis syndrome, and reflux asthma syndrome are the extraesophageal syndromes in association with GERD. Potential ways in which GER may contribute to reflux cough, laryngitis, and asthma syndromes involves both direct (aspiration) and indirect (neurally mediated) mechanisms. Chronic cough, defined as cough greater than 8 weeks duration, is a common condition seen by physicians. In nonsmoking patients with a normal chest radiograph, not taking angiotensin-converting enzyme (ACE) inhibitors, the most common causes of cough include postnasal drip syndrome (PNDS), asthma, GERD, and chronic bronchitis, and these four conditions may account for up to 90% of cases of chronic cough. It must be considered that some of the PNDS cases could be in relation with GERD. Patients with excessive esophageal acid exposure and positive reflux-cough associations have the best chance of responding to PPI treatment. In patients with GERD and chronic cough, the results of surgical treatment are controversial; Ege reflux study group suggests confining surgery for the patients only who have typical GERD symptoms. The current body of evidence largely supports the concept that neuronal crosstalk between the esophagus and airway drives the relationships between gastroesophageal reflux and cough, however present technologies limit our ability to accurately detect refluxate reaching the larynx, pharynx and lower airways. Future strategies for treating patients with cough reflux associations are likely to include treatments to modulate the numbers of reflux events or the underlying neuronal hypersensitivity.
... 61 Another study reported similar findings of intraesophageal acidity and acid reflux symptoms in 5/11 fasted runners and in 8/9 fed runners during or just after exercise. 62 Soffer et al, reported a direct correlation between exercise (cycling at a VO2 max of 75% and 90%) and decrease in intra-esophageal pH to below 4.0. In trained cyclists exercising at VO2 max of 75% and 90%, the number of episodes when the pH decreased below 4.0 were 1.2 and 3.7 episodes/hour. ...
Article
Atrial fibrillation (AF) is the most common cardiac arrhythmia in athletes, especially in middle-aged athletes. Studies have demonstrated that athletes who engage in endurance sports such as runners, cyclists and skiers are more prone to AF than other athletes. The effects of exercise on the onset and progression of AF is complex. Triggers of AF in athletes may include atrial ectopy and sports supplements. Substrates for AF in athletes include atrial remodeling, fibrosis, and inflammation. Modulators of AF in athletes include autonomic activation, electrolyte abnormalities, and possibly, gastroesophageal reflux. Management of AF in athletes with rate-controlling agents and antiarrhythmic drugs remains a challenge and can be associated with impaired athletic performance. The value of catheter ablation is emerging and should be considered in suitable athletes with AF.
... GERD symptoms tend to be common among athletes ( 2,3 ), with epidemiological data indicating that upper gastrointestinal symptoms occur in up to 58% of surveyed athletes ( 4,5 ). Previous studies have shown that strenuous exercise can induce excessive refl ux, both in patients with GERD and in asymptomatic healthy subjects ( 2,(6)(7)(8)(9)(10)(11)(12), and that this mainly occurs during vigorous exercise ( 2,10,13 ), suggesting that strenuous physical activity can be a risk factor for GERD. ...
Article
Full-text available
Objectives: Reflux symptoms are common among athletes and can have a negative impact on athletic performance. At present, the mechanisms underlying excess reflux during exercise are still poorly understood. The aim of this study was to investigate the effect of exercise on reflux severity and examine the underlying reflux mechanisms. Methods: Healthy sporty volunteers were studied using both high-resolution manometry and pH-impedance monitoring. After a meal and a rest period, subjects ran on a treadmill for 30 min at 60% of maximum heart rate, followed by a short rest period and another 20-min period of running at 85% of maximum heart rate. Results: Ten healthy volunteers were included. Exercise led to a significantly higher percentage of time with an esophageal pH<4 and a higher frequency and duration of reflux episodes. Moreover, exercise resulted in a decrease in contractility and duration of peristaltic contractions. The minimal lower esophageal sphincter resting pressure decreased during exercise, whereas the average and maximum abdominal pressure both increased. Importantly, the percentage of transient lower esophageal sphincter relaxations (TLESRs) that resulted in reflux significantly increased during exercise and all but one reflux episode occurred during TLESRs. In six subjects a hiatus hernia was detected during the exercise period but not during rest. Conclusions: Running induces gastroesophageal reflux almost exclusively through TLESRs. These are not more frequent during exercise but are more often associated with a reflux episode, possibly due to increased abdominal pressure, body movement, a change in esophagogastric junction morphology, and a decreased esophageal clearance during exercise.Am J Gastroenterol advance online publication, 12 April 2016; doi:10.1038/ajg.2016.122.
... Gastro-oesophageal acid reflux. Based on results from separate literature taken together, Swanson 85 hypothesizes that vigorous exercise may induce gastro-oesophageal acid reflux, [86][87][88] which in turn has been shown to increase the risk of atrial fibrillation by 39% in a large population study of 163,627 participants. 89 This hypothesis needs further elaboration. ...
Article
Although commonly associated with cardiovascular disease or other medical conditions, atrial fibrillation may also occur in individuals without any known underlying conditions. This manifestation of atrial fibrillation has been linked to extensive and long-term exercise, as prolonged endurance exercise has shown to increase prevalence and risk of atrial fibrillation. In contrast, more modest physical activity is associated with a decreased risk of atrial fibrillation, and current research indicates a J-shaped association between atrial fibrillation and the broad range of physical activity and exercise. This has led to the hypothesis that the mechanisms underlying an increased risk of atrial fibrillation with intensive exercise are different from those underlying a reduced risk with moderate physical activity, possibly linked to distinctive characteristics of the population under study. High volumes of exercise over many years performed by lean, healthy endurance trained athletes may lead to cardiac (patho)physiological alterations involving the autonomic nervous system and remodelling of the heart. The mechanisms underlying a reduced risk of atrial fibrillation with light and moderate physical activity may involve a distinctive pathway, as physical activity can potentially reduce the risk of atrial fibrillation through favourable effects on cardiovascular risk factors.
... Ils touchent majoritairement les cyclistes (67%), dont la compression abdominale due à la position est probablement une explication, puis viennent les triathlètes (52%) et en dernier lieu les coureurs de fond (36%) [19] . Dans l"étude de Lopez et al. [13] [20] , l"aviron [21] , le cyclisme, la natation… Le dénominateur commun de ces sports (outre la natation) est à un moment ou un autre une position favorisant la compression abdominale et un certain degré d"effort « à glotte fermé » augmentant aussi la pression intra-abdominale. ...
Thesis
La pratique sportive, ou du moins l'activité physique est de nos jours, tout autant unphénomène de société qu'un enjeu majeur de santé publique. Néanmoins celle-cis'accompagne d'évènements indésirables allant du plus bénin au plus grave. Les troublesdigestifs à l'effort recouvrent tout ce panel de gravité et se distinguent par leur fréquenceimportante, notamment lors des efforts de longue durée. Le triathlon longue distance en est à la fois le plus célèbre représentant ainsi que le prototype d'effort prolongé à l'origine de nombreuses études sur le sujet. Notre travail s'est attaché, dans une première partie à évoquer les nombreuses étiologies à l'origine de ce type de troubles ainsi que leur physiopathologie complexe, après avoir effectué quelques rappels anatomiques, histologiques et physiologique. Dans une seconde partie, nous nous sommes proposé d'évaluer la prévalence de la pathologie digestive à l'effort, de l'automédication et les relations éventuelles entre elles par l'intermédiaire d'une enquête ponctuelle réalisée lors de l'EmbrunMan du 15 Août 2011Celle-ci a été réalisée au moyen d?un questionnaire incluant l?ensemble des participants(abandons inclus). Nous avons pu étudier un échantillon de 283 triathlètes, parmi lesquels lestroubles digestifs avaient une prévalence de 68,9%. L?automédication était de 21,9%. Lejeune âge et le sexe masculin sont apparus comme étant des facteurs de risque.La conclusion a permis de mettre en lumière l?absence d?évolution patente concernant laprévalence, l?automédication ou les habitudes dans ce contexte
... Symptoms related to gastroesophageal reflux, such as belching, heartburn regurgitation and chest pain have been commonly reported in athletes and exercise has been proposed as a potential risk factor for gastroesophageal reflux disease (GERD) [17,[35][36][37][38][39][40][41][42]. It has been shown that exercise can exacerbate GERD, depending on the mode, durations and frequency exercise and nutrition state [38,[42][43][44][45][46][47][48]. ...
Article
Background: Physical activity can be involved in the prevention of gastrointestinal (GI)-tract diseases, however, the results regarding the volume and the intensity of exercise considered as beneficial for protection of gastrointestinal organs are conflicting. Aims and methods: The main objective of this review is to provide a comprehensive and updated overview on the beneficial and harmful effects of physical activity on the gastrointestinal tract. We attempted to discuss recent evidence regarding the association between different modes and intensity levels of exercise and physiological functions of the gut and gut pathology. Results: The regular, moderate exercise can exert a beneficial effect on GI-tract disorders such as reflux esophagitis, peptic ulcers, cholelithiasis, constipation and inflammatory bowel disease (IBD) leading to the attenuation of the symptoms. This voluntary exercise has been shown to reduce the risk of colorectal cancer. On the other hand, there is considerable evidence that the high-intensity training or prolonged endurance training can exert a negative influence on GI-tract resulting in the exacerbation of symptoms. Conclusion: Physical activity can exhibit a beneficial effect on a variety of gastrointestinal diseases, however, this effect depends upon the exercise mode, duration and intensity. The accumulated evidence indicate that management of gastrointestinal problems and their relief by the exercise seems to be complicated and require adjustments of physical activity training, dietary measures and medical monitoring of symptoms. More experimental and clinical studies on the effects of physical activity on GI-tract disorders are warranted. Especially, the association between the exercise intensity and data addressing the underlying mechanism(s) of the exercise as the complementary therapy in the treatment of gastrointestinal disorders, require further determination in animal models and humans.
... 165 Kürek ve koşu gibi ağır spor faaliyetlerinin gastroözofageal reflü oluşma ihtimalini artırarak diş erozyonu görülme oranını yükselttiği ifade edilmiştir. 166 Literatürde erozyonun yanı sıra bruksizme bağlı diş aşınma düzeyini ...
Thesis
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Aim: The purpose of this study is to analyse the results of some skiers from some cities (Bursa, Erzurum, İstanbul, Kars and Kayseri) in the Turkey Championship who competed in the branch of Alpine Skiing between 2005 and 2013. Material and method: The data of this study was taken from the competition results section of official website of Turkish ski federation (www.kayak.org. tr). Race results were analysed according to years, cities, athlete categories and the type of the race. SPSS 15 packet program was used while analysing the data. Results: There was a decrease in the number of athletes who attended to The Turkey Championship from Bursa 0.9%, Erzurum 40.84%, Kars 75.71%, Kayseri 71.5% while İstanbul was the only city that saw an increase by 65,31 percent. When looking at the numbers of athletes who were in the top ten , Bursa, Erzurum, Kars and Kayseri had the most athletes in 2006 season while İstanbul had the most in 2011 with 71 athletes. When looking at the numbers of medals Istanbul has the most gold and silver medals while Erzurum has the most bronze medals. According to the race results in children categories İstanbul, has a considerable superiority. In junior and senior categories Erzurum and bursa have the superiority. Conclusion: Istanbul, which is the only city that does not have a ski resort among these cities has the superiority in substructure in comparison to other cities thanks to the planning and a full year of training with both skiing and not skiing. However, atlhletes’ quitting sports in the following years and continuing their education abroad shows a nonsustaining success. In other cities, athletes’’ success especially after gençler category is because of their acceptance of sport as a profession. Key Words: Alpine Discipline, Ski, Turkish Championship
Article
Using a previously described approach to generating novel medical hypotheses, this paper shows how two separate medical literatures taken together can suggest new information not apparent in either literature alone. Many studies have demonstrated that aerobic exercise in healthy people can induce esophageal acidic reflux that increases with the duration and intensity of exercise. Separately, independently of exercise, it has been shown that, in patients with gastroesophageal reflux, esophageal acid exposure can lead to atrial fibrillation (AF) and to other heart dysrhythmias. The two arguments together suggest that a regimen of excessive exercise may be conducive to AF mediated by acid reflux, an implicit, but unpublished, hypothesis. Proton pump inhibitors are widely used to treat gastroesophageal reflux. Remarkably, several small clinical trials of these drugs have been shown also to reduce symptoms and frequency of AF episodes in patients with comorbid acid reflux. Plausible mechanisms have been suggested. These small-scale tests in a highly restricted population may be of particular interest in the light of a possible exercise-reflux-AF causal chain of events in a broader population of athletes. Because the minimum degree of esophageal acidity exposure required to induce AF is unknown, further tests of proton pump inhibitors for that purpose are therefore merited without regard to any known prior reflux in a population of runners with lone AF. The prospect of reducing AF burden with a relatively benign agent is attractive in view of the limited options for effective treatment otherwise available. The study of arrhythmia and esophageal reflux in athletes may offer insights on the origin and natural history of lone atrial fibrillation.
Article
Acid reflux occurs during exercise. The effects of esophageal acid and prophylactic antisecretory treatment on exercise performance are unknown. To determine 1) the effect of esophageal acid perfusion during exercise on pulmonary function and exercise performance, and 2) whether acid suppression with rabeprazole (RAB) 20 mg x d(-1) increases exercise performance during esophageal acid infusion. This was a two-phase study. Twenty-four conditioned runners (11 with heartburn, 13 without) completed phase 1. Sixteen runners with heartburn completed phase 2 (RAB). For phase 1, esophageal evaluation, baseline maximum exertion test, and a standard Bruce protocol maximal stress test were performed. Runners were randomized to sham esophageal infusion (NG tube placed in the distal esophagus, no fluid) or esophageal acid perfusion (0.1 N HCl perfused) during exercise. Subjects were crossed over to the alternate perfusion. For phase 2, runners underwent three sessions with both acid and sham perfusion during running; the sessions were randomly conducted on different days at baseline and 8 and 12 wk of RAB 20 mg. For phase 1, esophageal function and sensitivity were normal. There was no difference in airway resistance or work capacity between groups. The acid-perfusion group significantly decreased time to exhaustion in the no-heartburn group (23.13 to 20.66 min) with a decrease in energy expenditure. For phase 2, time to exhaustion was significantly decreased with acid perfusion at all time points (P < 0.05). Total energy expenditure during exercise was less in each acid-perfusion test. No difference in pulmonary function was present at week 12 versus baseline. Esophageal acid perfusion decreased performance. In runners with heartburn, suppression of endogenous acid secretion did not improve exercise performance. Changes in cardiopulmonary function do not explain the decreased exercise performance during acid perfusion.
Article
A globally acceptable definition and classification of gastroesophageal reflux disease (GERD) is desirable for research and clinical practice. The aim of this initiative was to develop a consensus definition and classification that would be useful for patients, physicians, and regulatory agencies. A modified Delphi process was employed to reach consensus using repeated iterative voting. A series of statements was developed by a working group of five experts after a systematic review of the literature in three databases (Embase, Cochrane trials register, Medline). Over a period of 2 yr, the statements were developed, modified, and approved through four rounds of voting. The voting group consisted of 44 experts from 18 countries. The final vote was conducted on a 6-point scale and consensus was defined a priori as agreement by two-thirds of the participants. The level of agreement strengthened throughout the process with two-thirds of the participants agreeing with 86%, 88%, 94%, and 100% of statements at each vote, respectively. At the final vote, 94% of the final 51 statements were approved by 90% of the Consensus Group, and 90% of statements were accepted with strong agreement or minor reservation. GERD was defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes. Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndromes, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes. It also proposes a new definition for suspected and proven Barrett's esophagus. Evidence-based global consensus definitions are possible despite differences in terminology and language, prevalence, and manifestations of the disease in different countries. A global consensus definition for GERD may simplify disease management, allow collaborative research, and make studies more generalizable, assisting patients, physicians, and regulatory agencies.
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Gastroesophageal reflux disease (GERD) is one of the most common disorders in the general population. In recent years, a marked increase in the occurrence of the disease worldwide has been noted. Intense exercise belongs to factors that are known to exacerbate symptoms of GERD. Episodes of reflux seem to be associated with the length and the intensity of the physical activity undertaken. Experimental studies suggest that the gastroesophageal reflux may be increased in athletes due to: decreased gastrointestinal blood flow; alterations of hormone secretion; changes in the motor function of the oesophagus and the ventricle; and the constrained body position during exercise. Disturbances of the balance between two areas of opposite pressure: intra-abdominal and intrathoracic, have also been proven to influence GERD events. GERD is found in sportspeople of various disciplines, but specific types of exercise may have significantly different impacts on the gastroesophageal reflux. Basic prevention of GERD comprise lifestyle and dietary interventions. Adjustments of the exercise load and avoiding meals and drinks about the time of physical effort may ease the symptoms. Unfortunately, in most patients, pharmacological measures are necessary. These include occasional application of antacids and blockers of histamine H2 receptors in mild forms of the disease, and a regular therapy with proton pump inhibitors (PPI) in the majority of other cases. An average dose of PPI varies from 20 to 40 mg/day and should be continued for 4–8 weeks. Unfortunately, symptoms of GERD frequently return and in these situations long-term acid suppression with PPI is usually necessary. As regular physical activity exerts beneficial health effects, the necessity of establishing associations between moderate, recreational exercise and GERD is needed.
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Chest pain is a common complaint of athletes in all age groups. In athletes, chest pain is often attributed to "chest tightness," and treatment for bronchospasm is considered. However, the causes of the pain are wide and varied, and the pain is referable to the many organ systems that localize to the thorax. Therefore, when treatment with bronchodilators fails, it becomes important to consider other nonasthmatic causes of the pain. These causes can be organized by system and are explained in this article. Cardiac causes are the most feared and, fortunately, are very rare in the adolescent setting. With a thorough knowledge of etiologies of chest pain, the physician can often make a diagnosis with only a history and a physical exam.
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Principles: Data on associations between physical activity and gastroesophageal reflux disease (GERD) have been inconsistent. Although experimental and clinical studies prove that exercise increases gastroesophageal reflux, epidemiological observations on the relationship between GERD and everyday physical effort deliver contradictory results. Our aim was to examine the association between the level of everyday physical activity and parameters of the disease (pH-metry, symptoms) in patients diagnosed with GERD. Methods: We assessed the level of physical activity in a survey of 100 consecutive GERD patients. All subjects had undergone 24-h pH monitoring in a tertiary setting and reported symptoms they experienced daily. Using the criteria of the short form of the International Physical Activity Questionnaire (7-day recall) we identified groups presenting with low (I), moderate (II) or high (III) levels of physical activity. The amount of physical activity was expressed as multiples of resting metabolic rate and minutes of performance during a week (METs-minute/week). For evaluation of relationships between everyday physical activity and pH-metric indices of GERD a multivariate regression analysis was performed. The parameters studied were adjusted for age, BMI, smoking and gender (as covariates). Results: We did not observe any association between the amount of everyday physical activity (expressed as log base 10 METs-minute/week) and pH-metric parameters of GERD evaluated 5 cm and 15 cm above the lower oesophageal sphincter (LES). Furthermore, we analyzed relationships between investigated parameters and covariates: age, BMI, smoking and gender. We found significant correlations only between the number of reflux episodes 15 cm above LES and gender (beta -0.25; p <0.05) and between the number of reflux episodes 5 cm above LES and age (beta -0.24; p <0.05). The number of self-reported symptoms did not differ among the three groups of physical activity level. It reached 6 in groups I and II, and 7 in group III (p = 0.07). However we must note that we found a weak, positive correlation between the number of symptoms reported by patients and METs-minute/week (r = 0.21, p <0.05). Conclusions: In view of our results the level of everyday physical activity is not associated with symptoms of GERD. This observation should be confirmed in other populations with GERD diagnosed upon pH-metric criteria.
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Management of patients with coronary artery disease is a major challenge for physicians, patients, and the healthcare system. Chest pain experienced by patients with coronary disease can be of noncardiac origin, and symptoms frequently related to gastroesophageal etiologies. The distal esophagus and the heart share a common afferent nerve supply, suggesting that location and radiation of perceived pain may be identical. In addition, there is substantial overlap between the prevalence of coronary disease and gastroesophageal reflux disease. Many physicians, including cardiologists, prescribe acid-reducing therapy to coronary patients. However, no prospective, randomized studies to date have evaluated the potential benefit of such treatments to prevent chest pain symptoms for these patients. We review the studies on noncardiac chest pain demonstrating reflux in patients with and without coronary disease. Also, the association of reflux with exertional chest pain and cardiac syndrome X is discussed. A rationale is presented for prevention of noncardiac chest pain in coronary patients, and the potential role of acid-suppressive therapy in managing these patients is discussed.
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Gastroesophageal reflux disease is a disorder in which gastric contents move from stomach to esophagus. Exercise is a recognized contributing factor to reflux in healthy volunteers and is reported to be proportional to exercise intensity and the type of exercise. Our aim was to explore changes in physiology occurring in conditioned runners, cyclists, and weightlifters. Ten subjects from each sport with >3-month history of exercise-induced heartburn were enrolled. Subjects underwent evaluation of fasting and fed esophageal pH, heart rate, GI symptom, and perceived exertion during standardized exercise routines at 65% (60 min) and 85% (20 min) of their maximal capabilities. Weightlifters experienced the most heartburn and reflux: 18.51 +/- 17.34% time esophageal pH </= 4.0 fasted and 35.81 +/- 34.33% time pH </= 4.0 fed. Runners developed mild symptoms and moderate reflux: 4.90 +/- 3.96% time pH </= 4.0 (fasted) and 17.16 +/- 7.90% time (fed). Cyclists exhibited mild symptoms and reflux: 3.97 +/- 5.44% time pH </= 4.0 fasting and 6.49 +/- 6.22% time fed. Our study demonstrates that strenuous exercise induces significant reflux and related symptoms in conditioned athletes.
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Strenuous exercise exacerbates gastro-oesophageal reflux and symptoms and this may be diminished by antisecretory medication with omeprazole. Fourteen well-trained athletes (13 men, one woman), who indicated suffering from either heartburn, regurgitation or chest pain during competition running, performed two experimental trials at 2-week intervals using a randomized, double-blind, placebo-controlled crossover design. During the 6 days preceding the trial and on the trial day itself either 20 mg of omeprazole or a placebo was administered. Two hours after a low-fat breakfast and 1 h after the last study dose, the trial started with five successive 50-min periods: rest, three running periods on a treadmill, and recovery. Reflux (percentage time and number of periods oesophageal pH <4) was measured with an ambulant pH system during these periods. Compared to rest, reflux lasted significantly longer and occurred more frequently during the first running period, irrespective of the intervention, whereas during the second running period this effect was only observed with the placebo. Reflux occurred for longer and more frequently with the placebo than with omeprazole, but this was significant during the first two running periods only. Seven subjects reported heartburn, regurgitation and/or chest pain during exercise, irrespective of the intervention. Only a minority of the symptom periods was actually associated with acid reflux and in all cases this concerned periods with heartburn. Running-induced acid reflux, but not symptoms, were decreased by omeprazole, probably because most symptoms were not related to acid reflux.
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Exercise-induced bronchoconstriction (EIB) occurs in the majority of patients with asthma. The relationship between asthma and gastro-oesophageal reflux (GER) is well defined, and the reports of exertional gastro-oesophageal acid reflux in healthy subjects, prompted us to study the relationship between EIB and GER. Following an overnight fast and medication withholding, 15 asthmatics and 15 normal subjects were placed on continuous monitoring of oesophageal pH and ECG. After baseline monitoring of oesophageal pH, at rest, for 30 min, spirometry was performed. Thereafter, the subjects underwent rigorous treadmill exercise for 8 min followed by spirometry, 10 min after running. Twelve out of 15 asthmatics and none in the control group demonstrated significant fall in FEV1 in response to exercise. However, only six out of 15 normal subjects and three in the asthmatic group had evidence of GER during or following exercise. We concluded that there is no significant correlation between EIB and GER in patients with asthma.
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Investigation of the motor events underlying gastroesophageal reflux has largely been confined to resting, recumbent subjects. The motor events associated with reflux during physical activity remain unknown. The aim of this study was to investigate the patterns of lower esophageal sphincter (LES) function underlying reflux in healthy subjects and the effect of exercise and physical activity on reflux mechanisms. LES pressure was recorded with a perfused sleeve sensor in 10 healthy subjects; intraluminal transducers recorded pressure in the stomach, esophagus, and pharynx, and pH was recorded 5 cm above the LES. Signals were stored in a portable data-logger. Recordings were made for 24 hours, including moderate physical activity, periods of rest and sleep, standardized meals, and standardized exercise. Most reflux episodes (81 of 123; 66%) occurred in the 3 hours after food intake; only 2 episodes occurred during exercise. LES pressure was < or = 3 cm H2O in 79% of reflux episodes. Transient LES relaxation was the mechanism of reflux in 82% of episodes, irrespective of activity or body position, whereas swallow-related LES relaxations accounted for 13% and persistently absent LES pressure accounted for 1%. Straining occurred in only 20% of episodes. In ambulant healthy subjects, accurate continuous recording of LES function is possible, reflux usually occurs during transient LES relaxations, and straining is not a major factor in the induction of reflux.
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Gastro-oesophageal reflux is commonly found in the general population, and has recently been demonstrated to occur more frequently during exercise than at rest. This fact is significant to the substantial number of athletes who complain of exertional upper gastrointestinal symptoms and exercise-induced chest pain. A diagnosis of exercise-induced gastro-oesophageal reflux can be confirmed by means of ambulatory pH monitoring. A positive diagnosis allows for appropriate management of the individual. This can involve simple measures, such as recommendations for changes in diet, timing of meals, and nature of exercise. However, pharmacological intervention may be required. A decrease in morbidity associated with cardiac origins of exercise-induced pain can also be expected with a more comprehensive understanding of this pathology.
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To compare the prevalence of gastroesophageal reflux disease (GERD) in surfers versus nonsurfers who participate in other sports activities based on the hypothesis that paddling in the prone position on hard surfboard surfaces leads to increased intra-abdominal pressure and GERD. A questionnaire survey using a modified Gastrointestinal Symptom Rating Scale. Data obtained from surfers and nonsurfer athletes on the island of Oahu in the state of Hawaii. One hundred eighty-five surfers and 178 nonsurfers who participate in sports activities. Surfer or nonsurfer status, type of surfboard used, frequency of surfing, and duration of surfing experience. The prevalence of reflux symptoms at least twice a week (GERD). The prevalence of GERD was significantly higher in short-board surfers than in nonsurfers with an odds ratio of 4.6 (28% versus 7%, P < 0.001) after adjustment for demographic variables using the multivariate regression model. GERD was more prevalent in short-boarders than long-boarders (28% and 12%, respectively). The prevalence of GERD increased significantly as both the frequency and duration of surfing experience increased (P < 0.001). Surfing is strongly associated with GERD. Short-board surfing appears to have a stronger association with GERD than long-board surfing.
Chapter
IntroductionEpidemiology of gastroesophageal reflux diseasePathophysiology of gastroesophageal reflux diseaseDiagnostic tests for gastroesophageal reflux diseaseTreatment of gastroesophageal reflux diseaseErosive gastroesophageal reflux diseaseTreatment of non-erosive reflux disease (NERD)Symptomatic gastroesophageal reflux disease: empirical therapy for uninvestigated patientsTreatment of esophageal peptic strictureEndoscopic treatmentsAnti-reflux surgeryReferences
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The prevalence of the symptoms of reflux (hearthburn and acid regurgitation) and of gastro-esophageal reflux disease is high. Numerous lifestyle modifications have been advocated in the prognosis of reflux. Obesity, the decubitus, eating rapidly, tobacco, alcohol and exercise provoke symptoms of the reflux (hearthburn and acid regurgitation). The proportion of fat in the food and stress aren’t factors associated with reflux. Some works point at the chocolate, at the acid juices, at the carbonated beverages and at the onions as factors that unleash symptoms of reflux. Nevertheless larger prospective controlled trials are warranted. Gum-chewing after eating, keep standing up and to go to bed 4 h after dinner improves the symptoms of the reflux and the gastro-esophageal reflux disease.
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The development of sports practicing is a new fact. The increasing participation of people to popular sport events (marathons, cycling sports…) and the development of recent concepts (triathlon, nature raids…) have generated the occurrence of a digestive symptomatology considered as "new" and specifically related to the effort. It affects sportspeople of any level, from simple amateurs to high-level athletes. This entity was initially observed in extreme sports and endurance sports. Although reported as anecdotes (e.g. the death of Philipides in Athens in 490 B.C. due to a hypothetical heat stroke, or Derek Clayton, vomiting at the end of his marathon victory in Antwerp in 1969,) there are numerous examples that have been largely shown by the widespread live broadcasting of sport events (e.g. the hospitalization of the triathlete Mark Allen due to epigastria cramps in Hawaii in 1988, the withdrawal of Sevilla Oscar from competition for the same reasons in the sixteenth stage of the Tour de France 2002, the withdrawal of Pete Sampras and Mary Pierce at Roland Garros due to digestive disorders in 1997…). Despite the difficulty of evaluating the exact prevalence of these digestive disorders, it seems that they may affect up to a quarter of the participants in endurance sports. The symptoms are described according to the localization of the lesion (oesophagus, stomach, intestines), and the degree of severity (primarily hemorrhagic demonstrations such as melaena and bloody diarrhoea). Liver diseases should not be forgotten, primarily exertional heat strokes and viral hepatitis. At least a cause of substandard performances for the athlete (cause of withdrawal in 5 to 15% of the cases during competitions), gastrointestinal disorders can present criteria of seriousness and be life-threatening, necessitating therefore rapid medical management, with a frequency of hospitalization shown to be 0.1 %.
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Exercise-related gastrointestinal symptoms are not uncommon among athletes. The occurrence of functional disorders including gastroesophageal reflux, bloating, vomiting, dyspepsia, acute diarrhoeal have been reported. The occurrence of gastrointestinal bleeding has also been reported especially in long-distance runners. The mucosal lesions could be related to hemodynamic changes in the splanchnic area. A decrease in splanchnic blood flow has been described during physical exercise. Exertional heat stroke results in a liver failure occurring after a long intensive exercise, often, but not always in a hot environment.
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Abstract Information on the mechanism of gastro-oesophageal reflux in patients with reflux disease is limited largely to studies in resting recumbent subjects. Evidence exists that both posture and physical activity may influence reflux. The aim of this study was to investigate reflux mechanisms in ambulant patients with reflux oesophagitis. Concurrent ambulatory oesophageal manometry and pH monitoring were performed in 11 ambulant patients with erosive oesophagitis. Lower oesophageal sphincter (LOS) pressure was monitored with a perfused sleeve sensor. Recordings were made for 90 min before and 180 min after a meal. At set times patients sat in a chair or walked. LOS pressure was ≤2 mmHg at the time of reflux for 98% of reflux episodes. Transient LOS relaxation was the most common pattern overall and the predominant pattern in seven patients, whilst persistently absent basal LOS pressure was the most common pattern in four patients. The pattern of LOS pressure was not altered by the presence of hiatus hernia or by walking. Straining occurred at the onset of 31% of acid reflux episodes but often followed the development of an oesophageal common cavity. The occurrence of straining was not influenced by walking. In ambulant patients with reflux oesophagitis: (1) LOS pressure is almost always absent at the time of reflux, usually because of transient LOS relaxation, (2) persistently absent basal LOS pressure is an important mechanism of reflux in a few patients, (3) straining may help to induce acid reflux in a variable proportion of occasions and may in some instances be a response to gas reflux, and (4) walking does not influence the occurrence of reflux or its mechanisms.
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