Exercise-induced vomiting

Gastrointestinal (GI) symptoms are common complaints reported by sportsmen. The incidence of such problems visibly differs in various data sources, but it concerns at least 20% [1] of athletes, in some studies reaching even 70% [2]. The occurrence of GI disorders depends on age, sex, training history and physical performance [1]. It also noticeably differs in various sport disciplines. In general, the most strongly affected group is endurance athletes participating in strenuous long-lasting exercise [3]. One of the best investigated and described groups is marathon runners. Up to 83% of them complain of GI signs and link them directly with running [4]. However, other sportsmen also experience GI symptoms during their training and competitions. Gastrointestinal complaints are usually divided into two groups according to the anatomical part of the GI tract which is affected. Upper gastrointestinal tract disabilities include nausea, vomiting, gastro-oesophageal reflux, heartburn and belching [5]. Those symptoms are generally common but more frequently concern cyclists in comparison to runners. Lower gastrointestinal tract symptoms, in contrast, are more often reported by runners [1] and comprise diarrhoea, intestinal cramping, gastrointestinal bleeding and flatulence [5–7]. Although the majority of athletes get used to exercise related GI symptoms and do not consider them as related to a disease, some of them look for medical help. The diagnostic process is especially necessary when physical performance of sportsmen is worsened by the GI signs. Such states often require numerous tests, imaging investigations, or even invasive examinations. Even though in most of the cases the causes are (more or less physiological) functional disorders, GI symptoms can be provoked by a somatic disease which needs medical treatment. The aim of this article is to describe a case of exercise related nausea and vomiting reported by a professional athlete, followed by an investigation into possible causes of such a condition. A 21-year-old male professional middle-distance runner was admitted to the hospital in order to diagnose exercise-induced vomiting. The symptoms occurred ep-isodically after strenuous training or after competitions, 4–5 times a year on average. The sole accompanying symptom was nausea a few seconds before the vomiting occurred, without any other announcing signs and no following complaints. The patient reported that he consumed the last meal always at least 2 h prior to the exercise. The content of vomiting was liquid with slight addition of bile. The patient's history did not reveal any chronic diseases. There was no history …