Clinical ReviewsThe Psychobiological Etiology of Gastrointestinal Distress in Sport A ReviewWilson, Patrick B. PhD, RDAuthor Information Department of Human Movement Sciences, Old Dominion University, Norfolk, VA The author declares that there is nothing to disclose. Address correspondence to: Patrick B. Wilson, PhD, RD, 2003A Student Recreation Center, Norfolk, VA 23529 (e-mail: firstname.lastname@example.org). Journal of Clinical Gastroenterology: April 2020 - Volume 54 - Issue 4 - p 297-304 doi: 10.1097/MCG.0000000000001308 Buy Metrics Abstract Gastrointestinal (GI) disturbances are common during training and competition, especially among endurance athletes. Historically, little attention has been paid to the psychobiological etiology of GI problems in sport. The aim of this review is to: (1) provide a physiological overview of how psychological stress and anxiety impact GI system function; (2) review the literature that has examined the role of stress and anxiety in GI distress in athletes; and (3) provide suggestions for future research. Animal and human studies have documented that psychological stressors reduce gastric motility and delay stomach emptying while simultaneously increasing large intestine motility. These functional changes are likely mediated through the secretion of corticotropin-releasing factor and subsequent alterations in autonomic nervous system activity, which act to reduce splanchnic blood flow and increase GI permeability. In addition, chronic stress and anxiety may worsen GI discomfort by increasing visceral hypersensitization. Still, only a couple of studies have found modest associations between stress, anxiety, and the occurrence/severity of GI distress in active populations. As such, future work should attempt to confirm that experimentally inducing psychological stress results in the aforementioned GI problems during exercise. Furthermore, studies are needed to determine how psychological stress impacts the tolerance to nutritional fueling and whether it worsens the GI permeability that normally occurs with exercise. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.