Occurrence and Impacts of Gastrointestinal Symptoms in Team-Sport Athletes: A Preliminary Survey.

OBJECTIVES: Although gastrointestinal (GI) symptoms are prevalent in endurance athletes, scant research has examined GI symptoms in team-sport athletes, their impacts, and explanatory factors. This study aimed to assess the prevalence and severity of GI symptoms in team-sport athletes and identify potential risk factors. DESIGN: An observational anonymous survey. SETTING: Online. PARTICIPANTS: Hundred forty-three athletes (79 men and 64 women) from team-based sports, with soccer, rugby, and American football athletes comprising approximately 75% of the sample. ASSESSMENTS OF RISK FACTORS: Age, gender, body mass index, competition experience, trait anxiety, and resting GI symptoms. MAIN OUTCOMES: Gastrointestinal symptoms during training and competition. RESULTS: Overall, past-month GI symptoms during training and competition were mild and relatively infrequent. However, 13.9% and 37.5% of men and women, respectively, reported that GI symptoms had ever impacted their performance. In comparison to men, women reported that nausea, bloating, and abdominal cramping were more likely to have affected performance ( P < 0.05). Women also had higher trait anxiety and higher scores for resting GI symptoms, during-training GI symptoms, and during-competition GI symptoms ( P < 0.001). Resting GI symptoms were the strongest predictor of training and competition GI symptoms (ρ = 0.46-0.67), although trait anxiety was also consistently correlated with competition GI symptoms (ρ = 0.29-0.38). CONCLUSIONS: This study suggests that female team-sport athletes experience a higher burden of GI symptoms than males, and that resting symptoms and anxiety predict competition symptoms. Interventions targeting anxiety could theoretically reduce GI symptoms in some team-sport athletes, but this should be confirmed through experimental designs.

Four weeks of probiotic supplementation reduces GI symptoms during a marathon race.

PURPOSE: To evaluate the effects of probiotic supplementation on gastrointestinal (GI) symptoms, circulatory markers of GI permeability, damage, and markers of immune response during a marathon race. METHODS: Twenty-four recreational runners were randomly assigned to either supplement with a probiotic (PRO) capsule [25 billion CFU Lactobacillus acidophilus (CUL60 and CUL21), Bifidobacterium bifidum (CUL20), and Bifidobacterium animalis subs p. Lactis (CUL34)] or placebo (PLC) for 28 days prior to a marathon race. GI symptoms were recorded during the supplement period and during the race. Serum lactulose:rhamnose ratio, and plasma intestinal-fatty acid binding protein, sCD14, and cytokines were measured pre- and post-races. RESULTS: Prevalence of moderate GI symptoms reported were lower during the third and fourth weeks of the supplement period compared to the first and second weeks in PRO (p < 0.05) but not PLC (p > 0.05). During the marathon, GI symptom severity during the final third was significantly lower in PRO compared to PLC (p = 0.010). The lower symptom severity was associated with a significant difference in reduction of average speed from the first to the last third of the race between PLC (- 14.2 ± 5.8%) and PRO (- 7.9 ± 7.5%) (p = 0.04), although there was no difference in finish times between groups (p > 0.05). Circulatory measures increased to a similar extent between PRO and PLC (p > 0.05). CONCLUSION: Probiotics supplementation was associated with a lower incidence and severity of GI symptoms in marathon runners, although the exact mechanisms are yet to be elucidated. Reducing GI symptoms during marathon running may help maintain running pace during the latter stages of racing.

Prevalence, Severity and Potential Nutritional Causes of Gastrointestinal Symptoms during a Marathon in Recreational Runners.

The purpose of the present study was to investigate the prevalence of gastrointestinal symptoms (GIS) amongst recreational runners during a marathon race, and potential nutritional factors that may contribute. Recreational runners of the 2017 Liverpool (n = 66) and Dublin (n = 30) marathons were recruited. GIS were reported post-marathon and we considered GIS in the 7 days prior to the marathon and during the marathon using the Gastrointestinal Symptom Rating Scale (GSRS). Nutritional intake was recorded using food diaries for the day before the race, morning of the race, and during the race; 43% of participants reported moderate (≥4) GIS in the 7 days prior to the marathon and 27% reported moderate symptoms during the marathon with most common symptoms being flatulence (16%) during training, and nausea (8%) during the marathon race. Correlations between all nutritional intake and GIS were not statistically significant (p > 0.05). There were significant correlations between total GIS score (r = 0.510, p < 0.001), upper GIS score (r = 0.346, p = 0.001) and lower GIS score (r = 0.483, p < 0.001) in training and during the marathon. There appears to be a modest prevalence of GIS in recreational runners, in the week prior to a marathon and during marathon running, although there was no association with nutritional intake before or during the race.

Seronegative enteropathy and malnutrition: a diagnostic challenge.

A 21-year-old woman presented with a 2-week history of vomiting, diarrhoea and epigastric pain, with 9 kg weight loss over the last two months. Laboratory tests were normal with negative coeliac serology. Duodenal biopsies revealed total villous atrophy, crypt hypertrophy and intraepithelial lymphocytosis. A diagnosis of seronegative coeliac disease was made, and she started a gluten-free diet. However, she did not respond and her weight fell to 30.6 kg (body mass index 11), becoming dependent on parenteral nutrition. Her diagnosis was reconsidered and the histology reviewed. The histopathological features were of severe active chronic duodenitis. By diagnosis of exclusion, with the absence of other clear pathology, she was treated as Crohn's disease. She responded to third-line therapy with biologics. In this case, the patient had refractory villous atrophy and the mucosal features, in addition to response with anti-tumour necrosis factor therapy, suggest inflammatory bowel disease, although not with complete diagnostic certainty.

Fungal liver abscess in an immunocompetent patient who underwent repeated ERCPs and subtotal cholecystectomy.

We report a case of a previously healthy female patient who initially presented with fever, jaundice and right upper quadrant pain three days after dilatation and stenting of a stricture of the common bile duct (CBD). During an earlier admission, the patient had undergone endoscopic retrograde cholangiopancreatography (ERCP) having presented with fevers and biliary dilatation on ultrasound. The ERCP features were more consistent with Mirizzi's Syndrome. The patient subsequently underwent subtotal cholecystectomy and later developed a CBD stricture, requiring repeat ERCP and stent insertion. At presentation, she had moderately deranged liver function tests and significantly elevated inflammatory markers and was found on cross-sectional imaging to have developed a liver abscess. Aspiration of the lesion cultured Candida albicans She was treated with intravenous antifungals, broad-spectrum antibiotics and further aspiration of abscess, which contributed towards her successful recovery. Fungal liver abscess should be suspected in immunocompetent patients who undergo ERCP and or cholecystectomy.

Recognition of familiar melodies by adult cochlear implant recipients and normal-hearing adults.

The purpose of this study was to compare melody recognition and pitch perception of adult cochlear implant recipients and normal-hearing adults and to identify factors that influence the ability of implant users to recognize familiar melodies. Forty-nine experienced cochlear implant recipients and 18 normal-hearing adults were tested on familiar melody recognition. The normal-hearing adults were significantly (p < 0.0001) more accurate than implant recipients. Implant recipients showed considerable variability in perception of complex tones and pure tones. There were significant negative correlations between melody recognition, age at the time of testing, length of profound deafness and complex-tone perception, and significant positive relations between melody recognition and speech recognition scores.