Gastritis in athletes: prevention, diagnosis, and when to see a doctor
Stomach pain and burning are among the most common reasons athletes look for a 'pill' at the pharmacy instead of seeing a doctor. Some of these conditions really do pass on their own, but some require examination and treatment. Our editors explain how to reduce the risk of gastritis, what diagnostic methods exist, and which symptoms require emergency care.
Prevention: what depends on the athlete
The main part of gastritis prevention is avoiding known irritants of the mucosa. These are above all the uncontrolled use of nonsteroidal anti-inflammatory drugs, excessive alcohol consumption, and smoking. Each of these factors harms the stomach on its own, and together they significantly reinforce one another.
The eating regime also matters. Regular meals, moderate portions before training, and a sufficient interval between eating and intense work reduce discomfort. It is usually advised to eat the main meal 2–3 hours before exercise, and closer to the workout — a small, light snack.
- do not take stimulants and concentrated supplements on an empty stomach;
- wash down carbohydrate gels with water, train the 'stomach' for feeding during events;
- avoid fatty and spicy dishes immediately before exercise;
- maintain hydration: dehydration intensifies mucosal ischemia;
- limit alcohol, especially after competitions and in combination with medications.
Supplements of iron, potassium, zinc, and vitamin C in high doses are better taken with meals, unless a doctor advises otherwise. Many athletes give up iron because of stomach discomfort, although the problem can often be solved by changing the time of intake or the form of the preparation — the question is worth discussing with a doctor.
Finally, screening for Helicobacter pylori is worth discussing with a doctor if there are persistent dyspepsia symptoms, peptic ulcer disease or stomach cancer in the family, or a need for long-term use of NSAIDs or aspirin. The Maastricht VI consensus recommends a 'test and treat' strategy for such groups.
Painkillers: how not to harm the stomach
Joint and muscle pain is a constant companion of sport, and NSAIDs seem a simple solution. However, the risk of gastrointestinal complications depends on the dose, duration, and accompanying factors. A short course as prescribed in a healthy person is one thing, while daily use 'just in case' is quite another.
| Factor | Effect on stomach risk | What to do |
|---|---|---|
| High dose, prolonged use | The risk rises | Minimum effective dose, shortest course |
| A history of ulcer | Substantially increases the risk | A doctor's consultation is mandatory |
| Combination with glucocorticoids, anticoagulants | Substantially increases the risk | Only under medical supervision |
| Several NSAIDs at once | Increases the risk without additional benefit | Do not combine |
| Use before a long event | Stomach, kidneys, dubious benefit | Avoid 'prophylactic' use |
For people at increased risk, a doctor may prescribe stomach protection — a proton pump inhibitor — or choose a different painkiller. Paracetamol is less aggressive toward the mucosa, but has its own limitations, in particular for the liver, and also should not be taken without supervision.
Topical forms of NSAIDs (gels, ointments) give a much lower systemic concentration and are a reasonable alternative for many superficial pains. However, here too you should follow the instructions.
Most important is to eliminate the cause of the pain: review the load, technique, and recovery. Chronic pain that 'holds on' only thanks to pills is a reason to consult a sports physician, not to increase the dose.
Diagnosis: from the breath test to gastroscopy
Diagnosis begins with a conversation with the doctor: the nature of the pain, its connection with food and training, the intake of drugs and supplements, and the family history. Already at this stage the doctor may identify 'alarming signs' that require immediate endoscopy.
To detect Helicobacter pylori, non-invasive methods are used: the urea breath test and detection of the bacterial antigen in stool. A serological blood test shows only past contact with the bacterium and is less suitable for assessing an active infection. It is important that proton pump inhibitors and antibiotics can give false-negative results, so before the test they are usually temporarily discontinued on the doctor's recommendation.
Gastroscopy (esophagogastroduodenoscopy) is the main method that allows seeing the mucosa, detecting erosions and ulcers, and taking a biopsy. It is the histological examination that confirms gastritis, determines its type, and detects precancerous changes. Endoscopy is recommended in the case of alarming symptoms, in older age, and when initial treatment is ineffective.
Additionally, the doctor may order a complete blood count (anemia), ferritin, and vitamin B12 (especially if autoimmune gastritis is suspected), and a stool test for occult blood. For endurance athletes, detecting iron deficiency may explain not only stomach symptoms but also a drop in results.
Principles of treatment and return to exercise
Treatment depends on the cause. When Helicobacter pylori is detected, eradication therapy is prescribed — a combination of antibiotics with a proton pump inhibitor; the doctor chooses the regimen taking local resistance into account. After treatment, it is mandatory to check whether the bacterium has been eliminated.
In gastritis associated with NSAIDs, the first step is to discontinue the drug or replace it with a safer option and, if necessary, a course of acid-lowering therapy. Alcohol and smoking are excluded during this time.
Proton pump inhibitors are effective, but long-term uncontrolled use is undesirable: the literature discusses a connection with impaired absorption of magnesium, B12, and iron, as well as changes in the gut microbiota. Therefore the duration of the course is determined by the doctor.
It is worth returning to intense training after symptoms have decreased. During treatment it is advisable to reduce intensity, avoid exhausting sessions in the heat, and be especially attentive to hydration and the eating regime. In the case of an ulcer or bleeding, the timing of return is determined by a gastroenterologist.
When to see a doctor
Some symptoms require immediate care, as they may indicate bleeding or perforation of an ulcer. These include vomiting blood or a mass resembling coffee grounds, black tarry stools, sudden severe abdominal pain, weakness, dizziness, and fainting.
Alarming signs that require a routine but prompt examination include unexplained weight loss, difficulty swallowing, persistent vomiting, anemia, pain that wakes you at night, and the appearance of symptoms in older age.
An ordinary doctor's consultation is needed if stomach discomfort lasts more than a few weeks, recurs after every workout, forces you to regularly take antacids, or if you constantly take NSAIDs or aspirin.
During the visit, report all medications, supplements, pre-workout formulas, and alcohol. This directly affects the diagnosis and the choice of treatment.
Editorial conclusions
Prevention of gastritis in athletes comes down to a few simple but important rules: a sensible approach to painkillers, moderation with alcohol, a thoughtful eating regime around training, and attention to supplements that irritate the stomach.
Diagnosis is based on non-invasive tests for Helicobacter pylori and on gastroscopy with biopsy; the choice of method depends on age and the presence of alarming signs.
Vomiting blood, black stools, and sudden severe abdominal pain are reasons to call for help immediately.
We also recommend familiarizing yourself with our materials on the causes of gastritis and its link to pharmacology, on irritable bowel syndrome, and on iron deficiency in athletes.
References
- Malfertheiner P, Megraud F, Rokkas T, et al. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022;71(9):1724–1762.
- Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112(2):212–239.
- Sugano K, Tack J, Kuipers EJ, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015;64(9):1353–1367.
- Lanas A, Chan FKL. Peptic ulcer disease. Lancet. 2017;390(10094):613–624.
- de Oliveira EP, Burini RC, Jeukendrup A. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations. Sports Med. 2014;44(Suppl 1):S79–S85.
- Warden SJ. Prophylactic use of NSAIDs by athletes: a risk/benefit assessment. Phys Sportsmed. 2010;38(1):132–138.
Andriy Melnyk
A strength-sports coach and author of programs for beginner and intermediate levels. Writes about training planning.
