Ileal ulcers in a long-distance runner diagnosed by capsule endoscopy.

tres daily was admitted into the hospital two years ago because of severe microcytic anemia (Hb: 9.2 g/dL, MCV: 71 fl). He was not taking anti-inflammatory drugs, or any other medication. Upper gastrointestinal endoscopy, ileocolonoscopy and small bowel barium follow-through were all normal. The patient was discharged on oral iron supplements with a diagnosis of chronic iron deficiency anemia of unknown origin. Two months ago, the patient was admitted again because of melena for three days. He had no other gastrointestinal symptoms. Blood tests showed a mild normocytic anemia (Hb: 11.1 g/dL, MCV: 87.1 fl). An upper gastrointestinal endoscopy showed a short-segment Barrett ́s esophagus without evidence of erosive esophagitis. A small-bowel follow-through was normal, and antiendomysial antibodies were negative. Capsule endoscopy showed two adjacent ulcers located in the proximal ileum (Fig. 1). After this diagnosis, the patient was advised to stop training. Nowadays, he is symptom-free and his hemoglobin level is 14.4 g/dL. Up to 20% of long-distance runners develop hemoccult-positive stools after a marathon, and there have been reported cases of overt gastrointestinal bleeding. Decreased gastrointestinal blood flow has been postulated as the main mechanism underlying gastrointestinal lesions during strenuous exercise. To our knowledge, this is the first case of running-associated small bowel ulcers diagnosed by capsule endoscopy (1-3).