distance running, sports injury

Minor bleeding from the gut is a common sports injury in increasingly popular sport of ultra-endurance running caused by the severe physical stress of ultra events. This problem, a reflection of the severe physical stress of ultra events, is particularly common among older athletes, women and people with existing gastrointestinal disorders.

No one knows the precise cause of this bleeding or whether it poses any long-term threat to health. But now a new study from Austria and Greece suggests that it can be prevented in many cases by a class of drugs known as ‘proton pump inhibitors’.

The effects of this drug were tested in 70 athletes taking part in the 2005 Spartathlon in Greece. This is one of the most gruelling running events in the world, covering a distance of 246k from Athens to Sparta, which has to be finished within 36 hours.

Half the athletes were given a proton pump inhibitor called pantoprazole to take for the three days of the race, while the rest took an identical-looking placebo. Samples of the athletes’ stools were analysed before and after the race for signs of ‘occult’ bleeding – traces of blood that might escape the naked eye. In the end only 37 of the runners – 20 from the treatment group and 17 from the placebo group – were included in the final analysis because some dropped out and others were excluded because they failed to finish within the specified time.

The results were impressive: two of the 20 athletes in the treatment group (10%) and 12 of the 17 in the placebo group (71%) had stool tests that were positive for bleeding. The researchers agreed that a short course of proton pump inhibitors ‘can successfully decrease the incidence of gastrointestinal bleeding in participants in an ultramarathon’.

However, they think these promising results need to be confirmed by larger studies. Meanwhile, they certainly don’t recommend this drug for every athlete taking part in gruelling events. ‘In athletes with increased risk of gastrointestinal bleeding, the use of prophylactic proton pump inhibition may be reasonable during heavy and/or prolonged sports activity’, they conclude.

Br J Sports Med 2006;40:359-362