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. 2025 Jun 1;37(6):691-701.
doi: 10.1097/MEG.0000000000002931. Epub 2025 Apr 29.

Gastrointestinal bleeding in long-distance runners: a systematic review

Miroslav Vujasinovic  1   2 , Masami Omae  1   2 , Nikola Panic  3 , Eva Fjellgren  4 , Nina Bloch  4 , Zdenko Kikec  5 , Marko Grasselli  5 , Greger Lindberg  1   2 , Johannes-Matthias Löhr  1   6 , Francisco Baldaque-Silva  1   2   7
Affiliations

Gastrointestinal bleeding in long-distance runners: a systematic review

Miroslav Vujasinovic et al. Eur J Gastroenterol Hepatol. .

Abstract

Objective: Long-distance running has become increasingly popular in recent decades all over the world. Besides musculoskeletal injuries, gastrointestinal (GI) complaints are also very common in athletes.

Methods: A systematic search limited to articles in the English language was performed to identify studies on GI bleeding in long-distance runners. The primary outcomes were the incidence and outcome of overt and occult GI bleeding in long-distance runners.

Results: A total of 51 articles were included in the final analysis. We found 22 articles reporting 36 cases of overt GI bleeding in long-distance runners. GI bleeding has been reported as a cause of death in one patient. Conservative treatment was used in most of the cases, and surgery was performed on four patients. We found 22 articles (759 runners included) related to occult GI bleeding and seven articles (6671 runners included) related to occult GI bleeding, based on questionnaire-based surveys.

Conclusion: Gastrointestinal bleeding may occur in long-distance runners, highlighting the need for further investigation into this issue. It is essential to conduct well-designed prospective studies on this topic, preferably using noninvasive diagnostic methods, such as capsule panendoscopy, to improve our understanding and management of this condition.

Keywords: athletes; bleeding; gastrointestinal; marathon; ultramarathon.

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