Abstract
ABSTRACT To the Editor.— In the reply to a question regarding the workup of abdominal pain in an otherwise healthy 17-year-old female distance runner (1983;249:409), I believe that several important points were omitted. Many distance runners will readily admit that running by itself is a natural cathartic. Severe stresses such as competition or intense practices can easily cause gastrointestinal (GI) distress. As previously noted (1980;243:1743), the increased parasympathetic nervous system tone found in runners could be involved with increasing baseline GI tract peristaltic activity in this patient. In addition, relative gut ischemia during exertion (1981;246:1404) could also be involved.Several key questions in the data base must be answered. Have there been any substantial changes in diet? Was there any history of lactose intolerance, malabsorption, or excessive carbohydrate intake (any of which could cause an osmotic diarrhea)? Was the stool checked for ova and parasites? Was the development of the patient's
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