What Causes Episodes Of Melena After Marathons?

Posted on Sat, 13 Dec 2014

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Sat, 13 Dec 2014 Answered on

Thu, 8 Jan 2015 Last reviewed on

Question : I'm a 45 female ultra runner, no medical problem, no history of colon cancer in my family. Had some episodes of melena after marathon, 100 km or 100 miles running in the last 6-7 years. Never in other circumstances. Recently I've had a blood test and discovered that I was anemic, hb 100, hematocrit 0,34, ferritin very low at 9 and vgm very low too. Reactive protein and sedimentation both normal..I use take Ains for a herniated disk in the last 3 minth( a lot). I've had a gastroscopy basically normal ( some mild gastritis) but after a month of using Prevacid... I suspect having some kind of gluten intolerance because since I've stop eating gluten 1 month ago, I stopped having abdominal pain( having them since I was a teenager)...Should I have a colonoscopy or wait ? I've read lots a medical literature about anemia and low ferritin being quite common in ultra runner...I'm a little worried!

Answered by Dr. Dr. Klerida Shehu (1 hour later)

Brief Answer:
I recommend doing Colonoscopy and...

Detailed Answer:
Hi XXXX!

I read your query and understood your concerns.

You are reporting that you had episodes of melena after marathons and this may be due to physical stress (stress ulcer and melena).

Also you're reporting that endoscopy found only a mild gastritis. Moreover laboratory test show anemia and low blood iron.

My opinionis that further examinations are necessary to find out the cause of anemia and melena.

If I was your treating doctor I would recommended not only Colonoscopy but the following examinations to:
- Abdominal ultrasound
- Abdominal ct scan

Moreover I would suggested to stop taking AINS and use gluten free food. These will improve your symptoms and will prevent future episode of melena and exacerbation of anemia.

Hope you will find these recommendations and suggestions helpful.
Wish you health!
Dr. Klerida

Above answer was peer-reviewed by : Dr. Prasad