The Compounding Mechanisms of Pre-Race Anxiety and Exercise on Gastroesophageal Reflux in Endurance Runners
Year: 2025
Type: article
Abstract: This review synthesizes the psychophysiological and biomechanical literature to elucidate the synergistic relationship between pre-race anxiety and exercise-induced gastroesophageal reflux (EIGER) in endurance runners. It details the independent mechanisms, including the role of the brain-gut axis in stress-induced acid secretion and esophageal vulnerability 1, and the biomechanical drivers of EIGER, such as increased transient lower esophageal sphincter relaxations (TLESRs).3 The central thesis is that pre-race anxiety creates a pro-reflux physiological state that is mechanically exploited by the act of running, leading to a compounding of symptoms. Quantitative evidence linking pre-race state anxiety to reflux (Odds Ratio 3.75) 4 and demonstrating that psychological factors account for 36% of the variance in gastrointestinal symptoms 5 is presented. Finally, the review analyzes the clinical implications of this model, particularly the poor response to proton pump inhibitors (PPIs) in high-anxiety athletes 6, and advocates for an integrated, evidence-based management strategy that combines pharmacological 7, nutritional 8, and essential psychobehavioral interventions, such as relaxation training 9 and diaphragmatic breathing.10
DOI: 10.17615/wgh7-tj25
Author: Thornton, Owen R
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416243457
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