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Questionnaire on Irritable Bowel Syndrome and Symptom Management Among Endurance Athletes Is Valid and Reliable

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Abstract

Background

Gastrointestinal symptoms are reported in a large proportion of endurance athletes, with similarities in symptom type and distribution to irritable bowel syndrome (IBS).

Aims

The objective of this study was to develop and validate a questionnaire to assess IBS diagnoses or fit to IBS diagnostic criteria in this population along with nutritional habits, gastrointestinal symptoms, and symptom management strategies.

Methods

A 93-item Endurance Athlete Questionnaire was developed to address the objective, targeted at American endurance athletes completing a marathon, ultra-marathon, half-distance triathlon, and/or full-distance triathlon that year. Content validity was established by expert reviewers (n = 6), and face validity was evaluated by endurance athletes (n = 9). Test–retest reliability was assessed by target athletes (n = 51). Participants completed two rounds of the questionnaire, separated by 1–2 weeks. Results were analyzed using Pearson and Spearman correlations and paired comparisons.

Results

Slight modifications in wording and three demographic questions were added based on the input of expert and athlete reviews. Pearson correlation coefficient of test–retest total questionnaire scores was significant at 0.839 (P < 0.001). Paired comparison of individual questions found significant differences in 10 of 236 analyzed responses; however, these did not affect fit to IBS diagnostic criteria for those without other GI diseases/disorders.

Conclusions

The Endurance Athlete Questionnaire proved to be a valid and reliable measure of IBS diagnostic criteria, gastrointestinal symptoms, nutritional habits, and symptom management strategies among endurance athletes. Future implementation will help inform gastroenterologists with endurance athlete patients and can elucidate whether certain behaviors could be contributing to athlete gastrointestinal symptoms.

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References

  1. Brouns F, Beckers E. Is the gut an athletic organ? Digestion, absorption and exercise. Sport Med. 1993;15:242–257.

    Article  CAS  Google Scholar 

  2. de Oliveira EP, Burini RC. The impact of physical exercise on the gastrointestinal tract. Curr Opin Clin Nutr Metab Care. 2009;12:533–538.

    Article  Google Scholar 

  3. de Oliveira EP, Burini RC, Jeukendrup A. Gastrointestinal complaints during exercise: prevalence, etiology, and nutritional recommendations. Sports Med. 2014;44:79–85.

    Article  Google Scholar 

  4. Peters HPF, Bos M, Seebregts L, et al. Gastrointestinal symptoms in long-distance runners, cyclists, and triathletes: prevalence, medication, and etiology. Am J Gastroenterol. 1999;94:1570–1581.

    Article  CAS  Google Scholar 

  5. Rehrer NJ, Janssen GM, Brouns F, Saris WH. Fluid intake and gastrointestinal problems in runners competing in a 25-km race and a marathon. Int J Sports Med. 1989;10:S22–S25.

    Article  Google Scholar 

  6. Rehrer NJ, van Kemenade M, Meester W, Brouns F, Saris WH. Gastrointestinal complaints in relation to dietary intake in triathletes. Int J Sport Nutr. 1992;2:48–59.

    Article  CAS  Google Scholar 

  7. Wright H, Medicine MS, Collins M, Martin P. Gastrointestinal (GIT) symptoms in athletes: a review of risk factors associated with the development of GIT symptoms. Int Sport J. 2009;10:116–123.

    Google Scholar 

  8. Peters HP, Van Schelven FW, Verstappen PA, et al. Gastrointestinal problems as a function of carbohydrate supplements and mode of exercise. Med Sci Sports Exerc. 1993;25:1211–1224.

    Article  CAS  Google Scholar 

  9. Fass R, Longstreth GF, Pimentel M, et al. Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome. Arch Intern Med. 2001;161:2081–2088.

    Article  CAS  Google Scholar 

  10. Drossman DA, Sandler RS, McKee DC, Lovitz AJ. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology. 1982;83:529–534.

    CAS  PubMed  Google Scholar 

  11. Hungin APS, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21:1365–1375.

    Article  CAS  Google Scholar 

  12. Priebe W, Priebe Y. Runners diarrhea: prevalence and clinical symptomatology [Abstract]. Am J Gastroenterol. 1984;79:827–828.

    Google Scholar 

  13. Saito YA, Schoenfeld P, Locke GR III. The epidemiology of irritable bowel syndrome in North America: a systematic review. Am J Gastroenterol. 2002;97:1910–1915.

    PubMed  Google Scholar 

  14. ter Steege RWF, van der Palen J, Kolkman JJ. Prevalence of gastrointestinal complaints in runners competing in a long-distance run: an internet-based observational study in 1281 subjects. Scand J Gastroenterol. 2008;43:1477–1482.

    Article  Google Scholar 

  15. Casey E, Mistry DJ, MacKnight JM. Training room management of medical conditions: sports gastroenterology. Clin Sports Med. 2005;24:525–540.

    Article  Google Scholar 

  16. Murray R. Training the gut for competition. Curr Sports Med Rep. 2006;5:161–164.

    Article  Google Scholar 

  17. ter Steege RWF, Kolkman JJ. Review article: the pathophysiology and management of gastrointestinal symptoms during physical exercise, and the role of splanchnic blood flow. Aliment Pharmacol Ther. 2012;35:516–528.

    Article  Google Scholar 

  18. Chey WD, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313:949–958.

    Article  CAS  Google Scholar 

  19. Putukian M, Potera C. Don’t miss gastrointestinal disorders in athletes. Phys Sportsmed. 1997;25:80–94.

    Article  CAS  Google Scholar 

  20. Drossman DA, Li Z, Andruzzi E, et al. U.S. Householder survey of functional gastrointestinal disorders—prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–1580. https://doi.org/10.1007/BF01303162 .

    Article  CAS  PubMed  Google Scholar 

  21. Saito YA, Locke GR, Talley NJ, et al. A comparison of the Rome and Manning criteria for case identification in epidemiological investigations of irritable bowel syndrome. Am J Gastroenterol. 2000;95:2816–2824.

    Article  CAS  Google Scholar 

  22. Saito YA, Talley NJ, Melton LJ III, Fett S, Zinsmeister AR, Locke GR III. The effect of new diagnostic criteria for irritable bowel syndrome on community prevalence estimates. Neurogastroenterol Motil. 2003;15:687–694.

    Article  CAS  Google Scholar 

  23. Keeffe EB, Lowe DK, Goss JR, Wayne R. Gastrointestinal symptoms of marathon runners. West J Med. 1984;141:481–484.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Lis D, Ahuja KDK, Stellingwerff T, Kitic CM, Fell J. Case study: utilizing a low FODMAP diet to combat exercise-induced gastrointestinal symptoms. Int J Sport Nutr Exerc Metab. 2016;26:481–487.

    Article  Google Scholar 

  25. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146:67–75.

    Article  CAS  Google Scholar 

  26. Drossman DA, Corazziari E, Delvaux M, et al. Appendix C: Rome III diagnostic questionnaire for the adult functional GI disorders (including alarm questions). In: Drossman DA, ed. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean: Degnon Associates, Inc.; 2006:917–952.

    Google Scholar 

  27. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2:653–654.

    Article  CAS  Google Scholar 

  28. Biddle SJH, Gorely T, Pearson N, Bull FC. An assessment of self-reported physical activity instruments in young people for population surveillance: project ALPHA. Int J Behav Nutr Phys Act. 2011;8:1.

    Article  Google Scholar 

  29. Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sciences. 5th ed. Boston: Houghton Mifflin; 2003.

    Google Scholar 

  30. Lis DM, Stellingwerff T, Kitic CM, Fell JW, Ahuja KDK. Low FODMAP: a preliminary strategy to reduce gastrointestinal distress in athletes. Med Sci Sports Exerc. 2017;50:116–123.

    Article  Google Scholar 

  31. Condrasky MD, Williams JE, Catalano PM, Griffin SF. Development of psychosocial scales for evaluating the impact of a culinary nutrition education program on cooking and healthful eating. J Nutr Educ Behav. 2011;43:511–516.

    Article  Google Scholar 

  32. Contento IR, Randell JS, Basch CE. Review and analysis of evaluation measures used in nutrition education intervention research. J Nutr Educ Behav. 2002;34:2–25.

    Article  Google Scholar 

  33. Risica PM, Burkholder G, Gans KM, et al. Assessing fat-related dietary behaviors among black women: reliability and validity of a new food habits questionnaire. J Nutr Educ Behav. 2007;39:197–204.

    Article  Google Scholar 

  34. Uggioni PL, Salay E. Reliability and validity of a questionnaire to measure consumer knowledge regarding safe practices to prevent microbiological contamination in restaurants. J Nutr Educ Behav. 2013;45:250–257.

    Article  Google Scholar 

  35. Eventbrite. Endurance sports participant study. 2014. http://eventbrite-s3.s3.amazonaws.com/marketing/britepapers/Endurance_Report_Survey.pdf. Accessed 1 Jan 2016.

  36. Running USA. 2016 state of the sport—U.S. road race trends. 2016. http://www.runningusa.org/state-of-sport-us-trends-2015. Accessed 1 Jan 2016.

  37. TribeGroup LLC. The mind of the triathlete. 2009. https://www.teamusa.org/usa-triathlon/about/multisport/demographics. Accessed 1 Jan 2016.

  38. Running USA. 2016 National Runner Survey. 2016. http://www.runningusa.org/2016-national-runner-survey. Accessed 1 Jan 2016.

  39. Lovell RM, Ford AC. Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clin Gastroenterol Hepatol. 2012;10:712–721.

    Article  Google Scholar 

  40. Dang J, Ardila-Hani A, Amichai MM, Chua K, Pimentel M. Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. Neurogastroenterol Motil. 2012;24:853-e397.

    Article  Google Scholar 

  41. Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology. 2013;145:1262–1270.e1.

    Article  Google Scholar 

  42. Mearin F, Lacy BE. Diagnostic criteria in IBS: useful or not? Neurogastroenterol Motil. 2012;24:791–801.

    Article  Google Scholar 

  43. Sood R, Gracie DJ, Law GR, Ford AC. Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers. Aliment Pharmacol Ther. 2015;42:491–503.

    Article  CAS  Google Scholar 

  44. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130:1480–1491.

    Article  Google Scholar 

  45. Dorn SD, Morris CB, Hu Y, et al. Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol. 2009;43:214–220.

    Article  Google Scholar 

  46. Rao SSC, Yu S, Fedewa A. Systematic review: dietary fibre and FODMAP-restricted diet in the management of constipation and irritable bowel syndrome. Aliment Pharmacol Ther. 2015;41:1256–1270.

    Article  CAS  Google Scholar 

  47. Riddoch C, Trinick T. Gastrointestinal disturbances in marathon runners. Br J Sports Med. 1988;22:71–74.

    Article  CAS  Google Scholar 

  48. Raedeke TD. The relationship between enjoyment and affective responses to exercise. J Appl Sport Psychol. 2007;19:105–115.

    Article  Google Scholar 

  49. Salmon J, Owen N, Crawford D, Bauman A, Sallis JF. Physical activity and sedentary behavior: a population-based study of barriers, enjoyment, and preference. Health Psychol. 2003;22:178–188.

    Article  Google Scholar 

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Acknowledgments

Research was conducted with support from a University of Illinois at Urbana-Champaign Division of Nutritional Sciences Margin of Excellence Research Award utilized for participant reimbursement.

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Authors and Affiliations

  1. Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 486A Bevier Hall, 905 South Goodwin Avenue, MC-182, Urbana, IL, 61801, USA

    Lauren A. Killian

  2. Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 343 Bevier Hall, 905 South Goodwin Avenue, MC-182, Urbana, IL, 61801, USA

    Karen M. Chapman-Novakofski

  3. Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, 351 Bevier Hall, 905 South Goodwin Avenue, MC-182, Urbana, IL, 61801, USA

    Soo-Yeun Lee

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  1. Lauren A. Killian
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Correspondence to Soo-Yeun Lee.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

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10620_2018_5289_MOESM1_ESM.docx

Additional file 1 is the final Endurance Athlete Questionnaire (EAQ) that was developed and validated in this study (DOCX 43 kb)

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Killian, L.A., Chapman-Novakofski, K.M. & Lee, SY. Questionnaire on Irritable Bowel Syndrome and Symptom Management Among Endurance Athletes Is Valid and Reliable. Dig Dis Sci 63, 3281–3289 (2018). https://doi.org/10.1007/s10620-018-5289-8

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  • DOI: https://doi.org/10.1007/s10620-018-5289-8

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