GERD and Dyspepsia in Pregnancy: Management Choices and Risks

As the uterus takes over, it doesn’t leave much room for the stomach, and all that pressure can push the stomach up, causing stomach acid to leak into the esophagus. Antacids are one of the most common over-the-counter medications to treat heartburn.

Most of the time, symptoms of heartburn improve after the baby is born. Heartburn or GERD are common discomforts which can start at any stage during pregnancy. An acid reflux pregnancy is not necessarily something to be alarmed about if managed with changes to your diet, lifestyle and, where necessary, treatment from a qualified physician following a thorough assessment. If you had gastroesophageal reflux disease (GERD) before pregnancy, heartburn is nothing new – but treating it during pregnancy might be.

Pregnant women with mild reflux usually do well with simple lifestyle changes. If lifestyle and dietary changes are not enough, you should consult your doctor before taking any medication to relieve heartburn symptoms.

CKS did not find any controlled studies on the effectiveness of omeprazole in pregnant women with dyspepsia, and the authors of a Cochrane systematic review noted the need for future research on the use of proton pump inhibitors (PPIs) for the treatment of heartburn in pregnancy [Phupong and Hanprasertpong, 2015]. However, trials of omeprazole in the general population, where it is known to be more effective than ranitidine [Christopher, 2005], coupled with a large amount of anecdotal evidence, can reasonably be extrapolated to suggest that it is an effective treatment in pregnancy. Dyspepsia in pregnancy is predominantly caused by gastro-oesophageal reflux disease (GORD). The diagnosis can be made on symptoms alone, which do not differ from the non-pregnant population. Heartburn and gastro-oesophageal reflux is associated with an increased severity of nausea and vomiting in pregnancy; managing heartburn and reflux may improve the severity of nausea and vomiting in pregnancy [Gill et al, 2009a].

LINX device. A ring of tiny magnetic beads is wrapped around the junction of the stomach and esophagus. The magnetic attraction between the beads is strong enough to keep the junction closed to refluxing acid, but weak enough to allow food to pass through. The Linx device can be implanted using minimally invasive surgery. Medications that block acid production and heal the esophagus.

However, if your heartburn is persistent, your doctor may suggest that you try an over-the-counter heartburn medicine that controls acid production, like proton-pump inhibitors (PPIs) or H2 blockers. They’re generally considered safe during pregnancy for women whose symptoms are severe and don’t respond to antacids and other lifestyle changes, but you’ll want to get the okay first from your practitioner. It is not known whether unexplained, transient relaxations of the sphincter, a common cause of reflux in women who are not pregnancy, it also occurs during pregnancy. It is not known if the contraction (motility) of the esophagus above the sphincter, a common contributor to GERD in women who are not pregnant is impaired in pregnancy, and is responsible for delaying the clearance of acid from the esophagus back into the stomach.

LBG In my practice, I encounter women who are contemplating pregnancy more commonly than women who are already pregnant; once women become pregnant, their obstetricians usually take over management, including management of GERD symptoms. The issue of whether PPI therapy should be discontinued is a common topic of conversation with my GERD patients who are contemplating pregnancy. In these patients, I usually recommend temporary cessation of PPI therapy during conception and pregnancy, if tolerated, but I also explain that the usage of these agents has been demonstrated to be safe and, therefore, they should be used if needed.

During normal digestion, food travels down the esophagus (the tube between your mouth and stomach), through a muscular valve called the lower esophageal sphincter (LES), and into the stomach. The LES is part of the doorway between your esophagus and your stomach. It opens to allow food through and closes to stop stomach acids from coming back up. Spicy foods, foods that have a lot of acid (like tomatoes and oranges), and coffee can make GERD symptoms worse in some people.

Gastroesophageal Reflux Disease (GERD) or heartburn is a common trigger for nausea and vomiting in pregnancy. Because of normal pregnancy changes, pregnant women are more likely to get heartburn even if they have never had it before. Avoid spicy foods and take over-the-counter antacids like Tums. If your heartburn persists beyond occasional doses of antacids, talk to your obstetric provider about starting an acid blocker medication which is safe in pregnancy. Most pregnant women have symptoms of gastroesophageal reflux disease (GERD), especially heartburn, at some point.

New safety alerts

This recommendation to refer to an obstetrician if symptoms suggest a pregnancy-related disorder other than dyspepsia is extrapolated from the NICE guideline on Antenatal care for uncomplicated pregnancies which advises the management and treatment of pregnant women by the appropriate specialist teams when problems are identified [NICE, 2008]. It is also pragmatic, based on what CKS considers to be good clinical practice.

There are severeal types of medications used to relieve heartburn in women who are not pregnent, but it is not kown how safe some of these medications are for the developing fetus. The most interesting finding from the 2010 Danish study was that there was an increased risk of birth defects in women who reported PPI usage 1-4 weeks before conception. However, the authors were unable to arrive at the same conclusions when they examined usage of omeprazole alone or usage of over-the-counter PPIs. Therefore, more research is needed to definitively conclude whether there is an increase in the risk of birth defects in patients who are on PPI therapy prior to becoming pregnant.

A consistent reduction in acid reflux will allow the esophagus to heal and become less sensitive. Over-the-counter antacids may prove helpful in relieving your heartburn, but do not take antacids without speaking to your healthcare provider. Some antacids contain high levels of sodium, which can cause fluid buildup in body tissues. Some also contain aluminum, which is not considered safe for pregnancy.

Together, these changes lead to reflux and possibly combine with decreased esophageal tone to cause ptyalism, or spitting, during pregnancy as well as reflux and heartburn. Heartburn can also be caused directly by your growing baby.

There are few data on the efficacy of lifestyle modifications in people with gastro-oesophageal reflux disease (GORD). However, evidence from small epidemiological studies suggests that lifestyle modifications may resolve symptoms in up to 25% of non-pregnant people with uncomplicated GORD [Madanick and Katz, 2006]. Once gastro-oesophageal reflux symptoms have developed, there is a high likelihood (approximately 50% each trimester) of the symptoms persisting during the pregnancy.

Health Solutions

Officially, heartburn is known as gastroesophageal reflux, when acidic stomach juices or food and fluids back up into the esophagus. This is a hollow muscular tube between your mouth and your stomach. Avoid other heartburn medications during pregnancy unless they’re prescribed by your doctor.

treatment for gerd in pregnancy
treatment for gerd in pregnancy

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