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Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow.
Aliment Pharmacol Ther. 2012 Mar; 35(5):516-28.AP

Abstract

BACKGROUND

The prevalence of exercise-induced gastrointestinal (GI) symptoms has been reported up to 70%. The pathophysiology largely remains unknown.

AIM

To review the physiological and pathophysiological changes of the GI-tract during physical exercise and the management of the most common gastrointestinal symptoms.

METHODS

Search of the literature published in the English and Dutch languages using the Pubmed database to review the literature that focused on the relation between splanchnic blood flow (SBF), development of ischaemia, postischaemic endotoxinemia and motility.

RESULTS

During physical exercise, the increased activity of the sympathetic nervous system (SNS) redistributes blood flow from the splanchnic organs to the working muscles. With prolonged duration and/or intensity, the SBF may be decreased by 80% or more. Most studies point in the direction of increased SNS-activity as central driving force for reduction in SBF. A severely reduced SBF may frequently cause GI ischaemia. GI-ischaemia combined with reduced vagal activity probably triggers changes in GI-motility and GI absorption derangements. GI-symptoms during physical exercise may be prevented by lowering the exercise intensity, preventing dehydration and avoiding the ingestion of hypertonic fluids.

CONCLUSIONS

Literature on the pathophysiology of exercise-induced GI-symptoms is scarce. Increased sympathetic nervous system activity and decreased splanchnic blood flow during physical exercise seems to be the key factor in the pathogenesis of exercise-induced GI-symptoms, and this should be the target for symptom reduction.

Authors+Show Affiliations

Department of Gastroenterology, University Medical Centre Groningen, The Netherlands. rinzetersteege@hotmail.comNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22229513

Citation

ter Steege, R W F., and J J. Kolkman. "Review Article: the Pathophysiology and Management of Gastrointestinal Symptoms During Physical Exercise, and the Role of Splanchnic Blood Flow." Alimentary Pharmacology & Therapeutics, vol. 35, no. 5, 2012, pp. 516-28.
ter Steege RW, Kolkman JJ. Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow. Aliment Pharmacol Ther. 2012;35(5):516-28.
ter Steege, R. W., & Kolkman, J. J. (2012). Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow. Alimentary Pharmacology & Therapeutics, 35(5), 516-28. https://doi.org/10.1111/j.1365-2036.2011.04980.x
ter Steege RW, Kolkman JJ. Review Article: the Pathophysiology and Management of Gastrointestinal Symptoms During Physical Exercise, and the Role of Splanchnic Blood Flow. Aliment Pharmacol Ther. 2012;35(5):516-28. PubMed PMID: 22229513.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow. AU - ter Steege,R W F, AU - Kolkman,J J, Y1 - 2012/01/10/ PY - 2011/06/24/received PY - 2011/11/09/revised PY - 2011/11/09/revised PY - 2011/12/16/accepted PY - 2012/1/11/entrez PY - 2012/1/11/pubmed PY - 2012/5/2/medline SP - 516 EP - 28 JF - Alimentary pharmacology & therapeutics JO - Aliment Pharmacol Ther VL - 35 IS - 5 N2 - BACKGROUND: The prevalence of exercise-induced gastrointestinal (GI) symptoms has been reported up to 70%. The pathophysiology largely remains unknown. AIM: To review the physiological and pathophysiological changes of the GI-tract during physical exercise and the management of the most common gastrointestinal symptoms. METHODS: Search of the literature published in the English and Dutch languages using the Pubmed database to review the literature that focused on the relation between splanchnic blood flow (SBF), development of ischaemia, postischaemic endotoxinemia and motility. RESULTS: During physical exercise, the increased activity of the sympathetic nervous system (SNS) redistributes blood flow from the splanchnic organs to the working muscles. With prolonged duration and/or intensity, the SBF may be decreased by 80% or more. Most studies point in the direction of increased SNS-activity as central driving force for reduction in SBF. A severely reduced SBF may frequently cause GI ischaemia. GI-ischaemia combined with reduced vagal activity probably triggers changes in GI-motility and GI absorption derangements. GI-symptoms during physical exercise may be prevented by lowering the exercise intensity, preventing dehydration and avoiding the ingestion of hypertonic fluids. CONCLUSIONS: Literature on the pathophysiology of exercise-induced GI-symptoms is scarce. Increased sympathetic nervous system activity and decreased splanchnic blood flow during physical exercise seems to be the key factor in the pathogenesis of exercise-induced GI-symptoms, and this should be the target for symptom reduction. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/22229513/Review_article:_the_pathophysiology_and_management_of_gastrointestinal_symptoms_during_physical_exercise_and_the_role_of_splanchnic_blood_flow_ L2 - https://doi.org/10.1111/j.1365-2036.2011.04980.x DB - PRIME DP - Unbound Medicine ER -