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    Tuesday, May 19, 2009

    Part II of II: GERD- Heartburn of Pregnancy

    Part II of II.

    Gastro-esophageal reflux is the phrase used to describe the backward flow or regurgitation of stomach contents passing up into the esophagus. The typical symptom of GERD is a burning discomfort behind the breast bone. Some describe heartburn as indigestion, a "sour" stomach, pain in the upper abdomen or chest, regurgitation of food or bitter liquid into the mouth or excessive production of saliva. GERD is a common condition and symptoms of heartburn are experienced at least once a month by more than 60 million Americans.

    For women, the first experience with heartburn is often during pregnancy. Studies suggest that over 50% of pregnant women will experience heartburn during pregnancy. This is due to hormones of pregnancy and pressure from the growing fetus. Symptoms of heartburn resolve in most of these women after delivery of the baby.

    What causes GERD?
    Acid is produced in the stomach every day. Normally, a small amount of acid passes into the esophagus through a valve between the esophagus and stomach called the lower esophageal sphincter. When the frequency or amount of acid in contact with your esophagus increases, symptoms and damage to your esophagus can occur.

    What are the stimuli of heartburn?
    Pregnancy
    Eating a large, especially fatty meal
    Tomato sauces (spaghetti & pizza)
    Lying down after a meal
    Chocolate, peppermint
    Coffee and tea
    Smoking
    Alcohol and carbonated beverages
    Some muscle relaxers and blood pressure medicines
    Excess weight
    Eat more frequent, but smaller meals

    What to avoid?
    fatty food, coffee & tea, chocolate, peppermint, alcohol, smoking, carbonated beverages.

    What to do?
    Maintain a normal weight
    Avoid eating 2-3 hrs before bedtime
    Elevate the head of the bed 4-6 inches
    Don’t lie down after eating

    What medications are effective in relieving symptoms?
    Antacids
    (liquid or tablets):
    Tums®, Rolaids®, Mylanta®, Maalox®, Gaviscon®, and many others.

    OTC Acid Blockers:
    Pepcid AC® , Tagamet HB® , Zantac AC® ., Prilosec OTC®
    *Important Note: If you are pregnant or nursing a baby, seek the advice of a doctor before using OTC acid blockers.

    Proton Pump Inhibitors:
    esomeprazole, Nexium®; or
    lansoprazole, Prevacid®; or
    pentaprazole, Protonix®; or
    rabeprazole, Aciphex®;

    Pro-motility Drugs:
    cisapride, Propulsid®

    Prescription Strength Antacids:
    sucralfate, Carafate®

    Prescription Strength H2 Blockers:
    cimetidine, Tagamet® , ranitidine, Zantac® , famotidine, Pepcid® , nizatadine, Axid®

    When should you see a doctor about symptoms of heartburn?

    If you have any of the following:
    Symptoms of heartburn two or more times a week
    Don’t get lasting relief on medication you are taking
    Difficulty swallowing, especially solids
    Choking, wheezing, hoarseness caused by regurgitation of acid into the throat
    Signs of bleeding (vomiting dark coffee ground-like material or passage of tarry black bowel movements)
    Unexplained weight loss
    Reflux symptoms over more than one year

    What treatments for heartburn are safe during pregnancy?
    During pregnancy, the medical treatment of reflux should be balanced to alleviate the mother’s symptoms of heartburn, while protecting the developing fetus.

    Step 1: Modification of diet & lifestyle

    Step 2: Antacids are probably safe.

    Sodium bicarbonate can cause a condition known as metabolic acidosis and should be avoided during pregnancy. Magnesium containing antacids may interfere with uterine contractions during labor and should be avoided during the last trimester of pregnancy.

    Step 3: sucralfate (Carafate®) has a good record for safety and results with pregnant patients. Acid blockers can probably be administered safely, but require a doctor’s supervision.

    Step 4: Other medical therapy should only be used when the benefit of the medicine for the mother outweighs the risk of the medicine to the developing fetus.


    Please remember, as with all our articles we provide information, not medical advice.

    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

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