EXERCISE-INDUCED GASTROESOPHAGEAL REFLUX

Abstract

The effect of exercise on gastroesophageal function was assessed in 7 children who were referred for evaluation of gastroesophageal reflux (GER). Four males and three females whose ages were 12.6 ± 4.4 yr were studied. Three patients presented with exercise-induced gastrointestinal symptoms (nausea, vomiting, substernal or epigastric pain). Cardiac or pulmonary disease was present in 3 children. Maximal treadmill exercise testing using the Bruce protocol with continuous monitoring of electrocardiogram and blood pressure was performed simultaneously with an esophageal pH probe study. Other diagnostic studies included upper GI series, 24-h pH probe, esophageal motility, gastroesophageal endoscopy, and biopsies. Results demonstrated that in one patient with exercise-induced gastrointestinal symptoms, significant symptomatic GER was present throughout strenuous exercise and during recovery ⩾ 40 min); no episodes of pathologic GER occurred throughout 24-h pH probe monitoring by Euler's criteria. Exercise-induced GER also was associated with biopsy-proven esophagitis. Motility studies demonstrated esophageal sphincter competency. None of the other patients demonstrated exercise-induced GER, despite the presence of pathologic GER. Physical work capacity was normal in all children. There were no pathologic ST changes associated with exercise. This is the first report of the association between exercise-induced gastrointestinal symptoms and GER. The pathophysiology of this entity is unknown. Exercise stress testing may aid in the diagnosis of exercise-induced GER.

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