Heartburn drug limits bleeding during long races

NEW YORK (Reuters Health) - Ultramarathon competitors may be able to prevent gastrointestinal bleeding by taking pantoprazole, a type of drug known as a proton pump inhibitor, before a race, a new study shows.

Austrian researchers found that athletes who took pantoprazole three days before competing in a 246-kilometer race were less likely to have blood in their stool after reaching the finish line.

Gastrointestinal disturbances, ranging from diarrhea to life-threatening bleeding, can occur among competitors in long-distance races, Dr. Gottfried H. Sodeck of Vienna General Hospital and colleagues note in the April issue of the British Journal of Sports Medicine.

"These symptoms may reflect the severe physical and psychological stress during long-distance running and may affect athletic performance; abdominal pain at the wrong moment may make the difference between winning and losing," they write.

Minor bleeding is common but rarely serious. However, women, older athletes, and those who experience bleeding during non-exercise periods are at greater risk, the researchers add.

Histamine H2 receptor antagonists, drugs traditionally used to treat ulcers, are ineffective for preventing GI bleeding during long distance runs, the researchers say. They therefore evaluated the effects of a proton pump inhibitor, a type of drug used to treat severe heartburn caused by erosive esophagitis associated with gastroesophageal reflux disease.

The researchers randomly assigned 70 athletes preparing to compete in the Spartathlon, a race from Athens to Sparta, to take 20 mg of pantoprazole or a placebo daily for three days before the race.

Thirty-seven of the study participants completed the race. Among the 20 who had taken the drug, two had blood in their stool, compared with 12 of the 17 runners given placebo.

Two athletes in the placebo group, who experienced gastrointestinal bleeding during non-exercise periods, had blood in their stool after the race. But none of the athletes with previous bleeding who took pantoprazole experienced bleeding during the race.

"This finding indicates that prophylactic proton pump inhibition may be effective for athletes with increased risk of gastrointestinal bleeding during heavy and/or prolonged sports activity," Sodeck and his team speculate.

However, they add that the drug can't be recommended for every runner.

SOURCE: British Journal of Sports Medicine, April 2006.