THE CLINIC: Track-Induced Nausea

Thu, 13 Sept. 2012 - 1:27 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
My son is a 16-year-old track runner. He has a lot of speed and promise, with one nagging problem. Upon completion of the 400 meters and relays, he vomits. It does not occur when he plays varsity soccer. He has competed at various sports since age six, many of which require extensive running, and we have never before seen this problem. His recent UGI indicated severe gastric reflux, and his GI specialist advised that he begin taking Prilosec and stop running. Are there other possible causes of this problem, and/or solutions?
 
Jean Harkens
Tucson, AZ
 
ANSWER:
Upper GI symptoms like belching, nausea, and vomiting are not uncommon in athletes. Maximal exertion, which occurs during sprinting, is often implicated. One reason gastric reflux occurs in runners is the transient relaxation of the lower esophageal sphincter secondary to the swallowing of air. This is not due to an increase in acid production, but a decrease in gastric mucosal secretions as blood is shunted away from the stomach and intestines to power the leg muscles. Delayed gastric emptying with strenuous exercise can contribute to the problem. Use of NSAIDs such as ibuprofen can make things worse. 
 
It does sound like your son has gastric reflux but has not found the right treatment regimen. I have treated many runners with this problem and would not recommend that your son give up running. Try the following in this order:
 
1. rule out any other potential cause, such as a cardiac problem
2. avoid large meals two to three hours prior to a race
3. try low-fat, low-protein liquid calorie/electrolyte solutions pre-race
4. avoid high concentration (hyperosmolar) feeds during training
5.  use isotonic replacement fluids during training
6. reduce training and crosstrain with lower-impact activities like swimming and cycling 
7. avoid lying down within three hours of a meal  
8. avoid restrictive clothes
9. avoid citric and tomato juices, caffeine, chocolate, anti-inflammatory medications, fatty foods, and alcohol
10. Try antacids like TUMS or Rolaids
11. Try nonprescription strength H2 receptor blockers (Zantac or Pepcid) taken before running and up to twice a day
12. Try prescription strength H2 receptor blockers taken before running and up to twice a day
13. Try proton pump inhibitors (such as Prilosec) taken once or twice daily
14. Try a combination of an H2 receptor blocker and a proton pump inhibitor
 
It bears repeating that I do not think your son needs to stop running.
 
Troy Smurawa, MD
Akron, OH
 
DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

(RUNNING & FITNEWS® April/March 2006 • Volume 24, Number 2)



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