EC GASTROENTEROLOGY AND DIGESTIVE SYSTEM EC GASTROENTEROLOGY AND DIGESTIVE SYSTEM Research Gastrointestinal Problems and their Risk Factors among Arba Minch Town Male Super League Football Club Players

Objective: The objective of this study was to assess the prevalence of exercise induced gastrointestinal problems and their risk factors among Arba Minch town male super league football club players. Result: A total of 31subjects participated in the study with a response rate of 100 %. The prevalence of GI symptoms is found to be 45.2%. Taking of NSAIDs frequently, doing exercise frequently and intensively, performing exercise on hot and humid environment and taking laxatives frequently identified as high risk factors. Unlikely, intake of tea/coffee for a long time and taking hypertonic fluid frequently are less risky to develop GI problem. According to this study prevalence exercise-induced gastrointestinal problems is high. Therefore, the concerned bodies shall intervene to tackle the problem.


Introduction
Soccer is a game played on a field between two teams of eleven players each with the object to propel a round ball into the opponent's goal by kicking or by hitting it with any part of the body except the hands and arms [1].
Exercise-related gastrointestinal symptoms are symptoms related to physiologic changes resulting from exercise [2]. Gastro-intestine (GI) is an important athletic organ because it is responsible for the delivery of water and nutrients during exercise [3].
The most frequent GI symptom caused by high-intensity exercise are heartburn, chest pain, bloating, belching, nausea, vomiting, abdominal cramp, frequent urge to defecate, diarrhea and constipation [4].
Frequently mode of exercise influences the occurrence and severity of gastrointestinal symptom (GIS) and sustained endurance exercise mediate increased permeability and damage in the GI tract [5,6]. More than 60% of endurance athletes report severe GIS during single-stage or multistage endurance competitions conducted in both hot and temperate ambient conditions [4]. Nearly, 4% -90% of endurance sport participants experience some adverse GI symptoms related to exercise including nausea, vomiting, abdominal cramps and the urge to have a bowel movement [7].
There is increased expression of GI disturbance symptomology in athletes after exercise of varying durations and intensity [8]. In Ethiopia both the prevalence and risk factors of exercise-induced GI problems had not been studied. So, this study aimed to asses' prevalence of exercise-induced GI problems and their risk factors.

Study area and period
The study was conducted in Arba Minch town, which is the capital city of Gamo zone, in south nation nationality region. It is 450 km away from Addis Ababa, the capital city of Ethiopia and 273.57 kilo meter from Hawassa, the capital city of the region. This study was conducted from March 1 -15, 2019.

Study design
Survey was employed.

Sample size and sampling technique
All thirty-one (31) male Arba Minch town super league football players were taken and Convenience sampling technique was used.

Data collection procedures
A questionnaire was first prepared in English and then translated into local language then back to English for checking consistency.
The questionnaires have three parts: socio-demographics characteristics, GI related problems and possible risk factors.
The data was collected by two data collectors and supervisors who hold BSc degree in sport science. Training was given for data collectors and supervisors. Pre-test was done on 5% of the total sample size out of the study area.

Data analysis
After checking for completeness, missed value, unlikely response, coded and entered to Epi data version 3.5.1 then exported to SPSS version 22 and then bivariate analysis was done. Cross-tabulation was done to see the association between GI symptoms with the risk factors.

Socio-demographic characteristics
A total of 31 football players participated in this study with a response rate of 100%. Fifteen (48.4%) of the participants were completed secondary school. Beyond Half of the participant 16 (51.6) % of the participants were Gamo ethnicity (See

Prevalence of gastrointestinal problems
The prevalence of gastrointestinal problems was 45.2% (See figure 1).

Risk factors
In the bivariate analysis, independent variables were cross-tabulated with the dependent variable after checking the assumption. Frequent use of NSAIDs, performing exercise strenuously and frequently, Taking hypertonic drink, Doing exercise in hot and humid environment frequently, Laxatives use and Taking tea/coffee for a long time are variables cross-tabulated with gastrointestinal problem.
Participants who had use NSAIDs frequently were more likely to develop GI problems than their counterparts (85.7% versus 17.6%), participants who had performing exercise strenuously and frequently were more likely to develop GI problems than who had not performing their exercise strenuously and frequently (92.9% versus 35.3%).
Those doing exercise in a hot and humid environment frequently were more likely to develop GI problem than their counterparts (85.7% versus 41.2%).
Participants who had using of laxatives for a long time were more likely to develop GI problem than that of who had not use laxative for a long time (85.7% versus 23.5%).
In other side participants who had taken hypertonic drinks frequently were less likely to develop GI problem than their counterparts (35.7% versus 41.2%).
Participants who had taken tea/coffee for a long period of time were less likely to develop GI problems than who had not taking tea/ coffee for a long period of time (35.7% versus 76.5%) (See table 2).

Discussion
The overall prevalence of gastrointestinal problems in this study was 45.2%, similar with the study conducted in Netherland [9].   However, it is lower than other study conducted Netherland [10]. The might be due to variation in sampling size, study design, fitness status of the participant.
Taking of non-steroidal anti-inflammatory drugs (NSAIDs) has significant association with GI problem; this study also showed that using NSAIDs frequently were more likely to develop GI problems (85.7%) than those who had not taking.
Frequent use of NSAIDs leads to gastrointestinal side effects and more rarely cardiovascular and nephrotoxic events and also relevant alterations of the training adaptive processes in terms of sports performance and decreased tissue healing in terms of a lack of rehabilitation, hence increasing the risk of recurrent injury [11]. Additionally, a study indicated that 1 in 5 athletes who are using NSAIDs reported that some NSAID-related side effects [12].
In this study those doing exercise strenuously and frequently were more likely to develop GI problem (92.9%) than their counterparts.
A self-report by 70% of athletes indicated that strenuous exercise and dehydration states resulted in GI symptoms [13].
Doing exercise in hot and humid environments is a risk factor. This study also showed that those doing exercise in hot and humid environments were more likely to develop GI problem than their counterparts (85.7 %). A study supports this finding that, athletes competing prolonged exercise events in the heat have reported symptoms such as, stomach cramps, intestinal cramps, diarrhea and gastrointestinal distress [13,14].
A history of laxative abusing is a risk factor for the occurrence gastrointestinal problem. This study showed that using of laxative for long period of time were more likely to develop GI problems (85.7%) than counterparts. Evidence indicated that using laxative causes abdominal discomfort by increasing the amount of stool [15].
In other side those consuming tea/coffee for long period of time were less likely to develop GI problem (14.3%). A study showed that withdrawing from caffeine for 0, 2, 12 and 24 or 48 hours before ingesting caffeine 5 mg/kg did not alter metabolic responses to steadystate endurance exercise and cannot effect on GI [16]. Based on the finding of this study, a participant who had taken hypertonic fluids frequently were less likely to develop GI problem than who had not taken hypertonic fluid (35.7%). Gastrointestinal stress is not observed until the concentration of carbohydrate is less than 8 % [17].

Conclusion
According to this study prevalence of exercise-induced gastrointestinal problems is high. use of NSAIDs frequently, performing exercise strenuously and frequently, frequently doing exercise in a hot and humid environment, using of laxatives for long period of time are identified as risk factors to develop gastrointestinal problem. Unlikely, taking tea/coffee for a long period of time and taking hypertonic fluid frequently were a minor risk factor.

Limitation of the Study
We are unable to generalize because of small sample size and there may be recall bias.

Ethics Approval and Consent to Participant
Ethical clearance and approval letter to conduct study was obtained from Arba Minch University ethical review board and a letter of cooperation was taken from the department of sport science. Written consent was taken from the participants before data collection and confidentiality of the information was ensured by coding. Participation was on a voluntary basis and responses were kept confidential.

Consent for Publication
Not applicable.

Availability of Data and Materials
The data that support the findings of this study are available wit out restriction.