title: Gastrointestinal mucosal integrity after prolonged exercise with fluid supplementation.
abstract: OBJECTIVE
  Studies on the effect of exercise on gastrointestinal (GI) mucosal integrity have been limited to occult-blood tests, which were often nonspecific for human blood. The aim of our study was to investigate more aspects of this integrity.
  
  
  METHODS
  We examined the effect of prolonged exercise and carbohydrate (CHO) supplementation on mucosal integrity in 22 male triathletes by measuring fecal lysozyme, alpha1-antitrypsin, and occult-blood loss, which was examined by two tests specific for human blood (Colon-Albumin and Monohaem test). Exercise consisted of two 150-min tests (alternately running, cycling, and running at 70-75% VO2max), either with a 7.0% CHO drink or water (W). Furthermore, GI symptoms during exercise were registered by questionnaire.
  
  
  RESULTS
  Three subjects showed human albumin only in the first stool after exercise: twice with W and once with CHO. However, human hemoglobin (Hb) could not be detected in these samples. Four other subjects showed an elevated lysozyme concentration after exercise with CHO but not with W. Elevated alpha1-antitrypsin values were found in three of seven specimens in which either positive albumin tests and/or an elevated lysozyme concentration were demonstrated. Twenty-one subjects (95%) reported one or more GI symptoms during exercise. Incidence rates of different GI symptoms varied from 5 to 68%. Most symptoms were more frequent and lasted longer during running than during cycling but did not differ significantly between supplements and were not related to any mucosal integrity parameter.
  
  
  CONCLUSIONS
  GI blood loss during exercise is of no clinical importance, at least in our study design with a group of well-trained male subjects who consumed a relatively high amount of fluid (up to 2.3 L). Nevertheless, an increased alpha1-antitrypsin and lysozyme concentration may indicate a transient local mucosal damage with an inflammatory response.
authors.affiliation: Department of Medical Physiology and Sports Medicine, Utrecht University, The Netherlands. h.p.f.peters@med.uu.nl
authors.forename: H P
authors.initials: HP
authors.lastname: Peters
authors.forename: W C
authors.initials: WC
authors.lastname: Wiersma
authors.forename: L M
authors.initials: LM
authors.lastname: Akkermans
authors.forename: E
authors.initials: E
authors.lastname: Bol
authors.forename: R J
authors.initials: RJ
authors.lastname: Kraaijenhagen
authors.forename: W L
authors.initials: WL
authors.lastname: Mosterd
authors.forename: W R
authors.initials: WR
authors.lastname: de Vries
authors.forename: J P
authors.initials: JP
authors.lastname: Wielders
mesh_terms: D000328:Adult; D000418:Albumins / Q000032:analysis; D001642:Bicycling / Q000502:physiology; D002637:Chest Pain / Q000209:etiology; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004884:Eructation / Q000209:etiology; D005243:Feces / Q000737:chemistry / Q000201:enzymology; D005440:Fluid Therapy; D005753:Gastric Mucosa / Q000502:physiology*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007413:Intestinal Mucosa / Q000502:physiology*; D008297:Male; D009113:Muramidase / Q000032:analysis; D009780:Occult Blood; D005082:Physical Exertion / Q000502:physiology*; D012420:Running / Q000502:physiology; D011795:Surveys and Questionnaires; D014867:Water / Q000008:administration & dosage; D000515:alpha 1-Antitrypsin / Q000032:analysis
chemical_list: D000418:Albumins; D004040:Dietary Carbohydrates; D006454:Hemoglobins; D000515:alpha 1-Antitrypsin; D014867:Water; D009113:Muramidase