The Compounding Mechanisms of Pre-Race Anxiety and Exercise on Gastroesophageal Reflux in Endurance Runners

<span style="font-weight: 400;">This review synthesizes the psychophysiological and biomechanical literature to elucidate the synergistic relationship between pre-race anxiety and exercise-induced gastroesophageal reflux (EIGER) in endurance runners. It details the independent mechanisms, including the role of the brain-gut axis in stress-induced acid secretion and esophageal vulnerability </span><span style="font-weight: 400;">1</span><span style="font-weight: 400;">, and the biomechanical drivers of EIGER, such as increased transient lower esophageal sphincter relaxations (TLESRs).</span><span style="font-weight: 400;">3</span><span style="font-weight: 400;"> The central thesis is that pre-race anxiety creates a pro-reflux physiological state that is mechanically exploited by the act of running, leading to a compounding of symptoms. Quantitative evidence linking pre-race state anxiety to reflux (Odds Ratio 3.75) </span><span style="font-weight: 400;">4</span><span style="font-weight: 400;"> and demonstrating that psychological factors account for 36% of the variance in gastrointestinal symptoms </span><span style="font-weight: 400;">5</span><span style="font-weight: 400;"> is presented. Finally, the review analyzes the clinical implications of this model, particularly the poor response to proton pump inhibitors (PPIs) in high-anxiety athletes </span><span style="font-weight: 400;">6</span><span style="font-weight: 400;">, and advocates for an integrated, evidence-based management strategy that combines pharmacological </span><span style="font-weight: 400;">7</span><span style="font-weight: 400;">, nutritional </span><span style="font-weight: 400;">8</span><span style="font-weight: 400;">, and essential psychobehavioral interventions, such as relaxation training </span><span style="font-weight: 400;">9</span><span style="font-weight: 400;"> and diaphragmatic breathing.</span><span style="font-weight: 400;">10</span>