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Aggravation of Exercise-Induced Intestinal Injury by Ibuprofen in Athletes

VAN WIJCK, KIM1,2; LENAERTS, KAATJE1,2; VAN BIJNEN, ANNEMARIE A.2; BOONEN, BAS2; VAN LOON, LUC J. C.1,3; DEJONG, CORNELIS H. C.1,2; BUURMAN, WIM A.2

Medicine & Science in Sports & Exercise: December 2012 - Volume 44 - Issue 12 - p 2257–2262
doi: 10.1249/MSS.0b013e318265dd3d
Clinical Sciences

Introduction: Nonsteroidal anti-inflammatory drugs are commonly used by athletes to prevent anticipated exercise-induced pain, thereby putatively improving physical performance. However, these drugs may have potentially hazardous effects on the gastrointestinal (GI) mucosa during strenuous physical exercise. The aim of the current study was to determine the effect of oral ibuprofen administration before exercise on GI integrity and barrier function in healthy individuals.

Methods: Nine healthy, trained men were studied on four different occasions: 1) 400 mg ibuprofen twice before cycling, 2) cycling without ibuprofen, 3) 400 mg ibuprofen twice at rest, and 4) rest without ibuprofen intake. To assess small intestinal injury, plasma intestinal fatty acid binding protein (I-FABP) levels were determined, whereas urinary excretion of orally ingested multisugar test probes was measured using liquid chromatography and mass spectrometry to assess GI permeability.

Results: Both ibuprofen consumption and cycling resulted in increased I-FABP levels, reflecting small intestinal injury. Levels were higher after cycling with ibuprofen than after cycling without ibuprofen, rest with ibuprofen, or rest without ibuprofen (peak I-FABP, 875 ± 137, 474 ± 74, 507 ± 103, and 352 ± 44 pg·mL−1, respectively, P < 0.002). In line, small intestinal permeability increased, especially after cycling with ibuprofen (0–2 h urinary lactulose/rhamnose ratio, 0.08 (0.04–0.56) compared with 0.04 (0.00–0.20), 0.05 (0.01–0.07), and 0.01 (0.01–0.03), respectively), reflecting loss of gut barrier integrity. Interestingly, the extent of intestinal injury and barrier dysfunction correlated significantly (RS = 0.56, P < 0.001).

Conclusion: This is the first study to reveal that ibuprofen aggravates exercise-induced small intestinal injury and induces gut barrier dysfunction in healthy individuals. We conclude that nonsteroidal anti-inflammatory drugs consumption by athletes is not harmless and should be discouraged.

1Top Institute Food and Nutrition, Wageningen, THE NETHERLANDS; 2Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center+, Maastricht, THE NETHERLANDS; and 3Department of Human Movement Sciences, NUTRIM, Maastricht University Medical Center+, Maastricht, THE NETHERLANDS

Address for correspondence: Kim van Wijck, M.D., Department of Surgery, Maastricht University, PO Box 616, NL-6200 MD Maastricht, The Netherlands; E-mail: k.v.wijck@gmail.com.

Submitted for publication May 2012.

Accepted for publication June 2012.

©2012The American College of Sports Medicine