Posts Tagged ‘heartburn’

How to Stop Heartburn During Pregnancy

Friday, February 4th, 2011

Heartburn in PregnancyThis is the second half of my blog regarding heartburn in pregnancy. The first half explained the causes and symptoms and together, hopefully, will quickly help you solve the burning symptoms of heartburn should they arise.

Therapy
As in most other conditions during pregnancy, behavioral modifications are always attempted initially. Drug therapy is reserved for the more severe cases. Avoidance of all medications during the first trimester, unless absolutely essential, is always considered sound advice.

  1. Lifestyle Changes
  2. Drug Therapy
    1. Antacids: The treatment of choice. The antacids neutralize the acid of the stomach juice and thus prevent its caustic effects on the lining of the esophagus.
    2. Sucralfate: Sucralfate, (Carafate- 1 gram three times a day), similar to antacids, is an aluminum salt that inhibits gastric acid, and does not get absorbed. It is considered safe in pregnancy and in breast-feeding women.
    3. GI Stimulant or Prokinetic agents: Metoclopramide is a drug that raises lower esophageal pressure and is also an anti-emetic. It is very effective in controlling heartburn of pregnancy and considered safe in pregnancy. A recent study in The New England Journal of Medicine by Matok concluded that metoclopramide in the first trimester was not associated with increased risks of any major congenital malformations, perinatal death, preterm birth, low birth weight, or low Apgar scores.
    4. H2 Receptor Blockers: (Pepsid and Axid, Cimetidine, Famotidine, and Nizatidine) The drugs in this category inhibit gastric acid secretion. These drugs are used in women with severe heartburn. Even though animal studies have not shown any adverse effects of the fetus, very little data is available in humans. These drugs should therefore be avoided in pregnancy if possible.
    5. Proton pump inhibitors: (Prilosec, Lansoprazole) Similar to H2 Blockers, these drugs also block gastric acid secretion. These drugs are more effective and have more rapid onset of action in relieving the symptoms of GERD compared to H2 receptor blockers. Two recent articles, one published by The American College of Gastroenterology by Gill in 2009 and another published by New England Journal of Medicine in 2010 by Pasrternick confirmed the safety of the use of Prilosec during pregnancy. Further studies need to be done to determine the safety of use during lactation and also risks with other drugs in this category.

In summary: Reflux is common in pregnancy. In most cases the condition responds well to lifestyle changes. More severe cases may require drug therapy. Antacids alone or in combination with alginic acid used after meals or at bedtime provide excellent relief in most cases.  In refractory cases, H2 receptor blockers should be considered but used sparingly (once a day rather than twice a day) after dinner. PPI’s as of recent data have now also been proven to be both safe and effective drug therapy.

Women suffering from heartburn should be reassured about the temporary nature of this condition and the fact that it will not affect the well being of the growing fetus.

Active management of heartburn can improve the pregnant woman’s quality of life.

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Fire in the Belly: Heartburn During Pregnancy

Wednesday, January 19th, 2011

Heartburn in PregnancyThere’s no greater surprise for a woman than learning she is pregnant for the first time… except for the first time she experiences one of mother nature’s unkindest pregnancy symptoms. Heartburn!

Reflux, as heartburn is commonly called, can be one of the most frightening moments of early pregnancy, especially when the woman is unaware that it may occur at any time. The searing pain often arrives without warning and the burn can grow even more intense very quickly. Then, just when she feels about to ignite, the pain crests and fades gently away… only to rear it’s fiery head again a few minutes later. Heartburn should never come as a surprise to a pregnant woman, and that’s why I am writing about the syndrome in great detail today.

Gastro-esophageal reflux, the flow of gastric content back from the stomach into esophagus is associated with heartburn and is one of the most common complaints in pregnancy. The symptoms are generally limited to pregnancy and other than the associated discomfort, have no adverse effects on the mother or the developing fetus.

Incidence of Heartburn in Pregnancy

This condition is extremely common and affects an estimated 80% of all pregnant women.
In the majority of cases reflux appears for the first time during pregnancy. In some however pregnancy exacerbates a pre-existing condition.
The incidence of heartburn is similar in the first or subsequent pregnancies.
Women with previous reflux during a pregnancy are more likely to have it again.
Caucasian women are likely to experience reflux earlier than black women.

Symptoms often begin early in pregnancy. However,
reflux becomes notable in the 5th month and gradually worsens as pregnancy progresses due to the enlarging uterus.

In the last month as the fetal head descends into the pelvis, symptoms often improve. The majority of women experience complete resolution of their symptoms after delivery.


Causes of Heartburn in pregnancy

Reflux in preganancy is caused by a combination of increased abdominal pressure and weakening of the muscle band constricting the lower esophagus (sphincter). The enlarging uterus compresses the stomach and increases the pressure within it. This increased pressure pushes fluid from the stomach into the esophagus. At the same time, the muscle band between the stomach and the esophagus, which normally prevents backward flow, becomes lax due to the effect of pregnancy hormones (estrogen and progesterone) and thus allows the stomach content to flow “backwards”.

Other more controversial explanations for reflux include:
Increased gastric acidity, making the gastric juice more irritating to the esophagus.
Increased stomach volume,
The emptying of the stomach is delayed during pregnancy,
Weakening of the muscle band between the stomach and intestine (pyloric sphincter) allowing bile to regurgitate from the small bowel into the stomach and from there into the esophagus.

Symptoms

Heartburn: the most common complaint. It presents as a sensation of burning in the chest that travels from the central part of the rib cage to the neck. Heartburn is more common and becomes more severe in the later months.
Regurgitation: Passage of fluid from the stomach into the esophagus and occasionally into the mouth is extremely uncomfortable and causes significant distress. It worsens after eating and especially when reclining immediately after a meal.
Less frequent symptoms include: Difficulty swallowing, chest pain, cough, wheezing, sore throat, hoarseness, asthma, ear, nose and throat abnormalities.

Diagnosis

Due to pregnancy and risk to the fetus, the diagnosis is often made by history alone. Endoscopy, telescopic visualization of the esophagus and stomach, which is usually done in the non-pregnant state, is deferred unless there are severe symptoms unresolved by routine measures. Severe symptoms may include bleeding, severe esophagitis, or strictures. (narrowing of the esophagus) Other diagnoses that can present similarly such as peptic and duodenal ulcer disease, H. pylori infections, Zollinger Ellison syndrome, and gallbladder disease should all be ruled out. Women with GERD during pregnancy may be more susceptible to complications when anesthesia is administered during labor or for emergency situations due to chemical pneumonias that can occur from aspiration of gastric contents. Therefore, anesthesiologists will administer medication in labor for prevention.

Active management of heartburn can improve a pregnant woman’s quality of life, therefore my next blog will review several effective therapies.

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The information provided in these articles and on this website is intended for educational and informational purposes only.
This information should not be used in place of an individual consultation or examination or replace the advice of your medical professional,
and should not be relied upon to determine diagnosis or course of treatment.
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