Abstract
REVIEW OF MANAGEMENT APPROACHES TO PREGNANCY INDUCED HEARTBURN

Okelue Edwards Okobi MD, M.Sc.*, Iboro Obot Udoete MD, Nkechi. Jane Nwafor MBBS, Henry Elukeme MD, Rita K. Okobi B.Sc. and Okoeguale Joseph M.B.B.S, M.Sc. FWACS

ABSTRACT

Heartburn or Gastroesophageal reflux disease (GERD) is a common digestive disorder during pregnancy occurring in about 30%-50% of pregnant women.[1] It occurs when the lower esophageal sphincter fails to close tightly, causing food and stomach acids to flow black (reflux) into the esophagus. In pregnancy, GERD occurs mainly due to the effect of progesterone, which reduces the reliability of the esophageal sphincter. Acidic food causes the inflammation of the esophageal lining and hence gives rise to burning chest pain, sour taste, and cough. Diagnosis can be clinical or by upper endoscopy. Gastroenterologists and obstetricians work together to optimize treatment. For most patients, lifestyle modifications and healthy diet plans are helpful but may be insufficient in providing a definitive cure. Therefore, some patients may require a more intense management approach or even surgery to reduce the symptoms. Antacids and sucralfate are considered first-line drug therapy.[2] If symptoms persist despite using the first-line therapies, Histamine-2 blockers (famotidine, cimetidine) may be used. In complicated cases where pregnant women have intractable symptoms, proton pump inhibitors (omeprazole, lansoprazole) are reserved.[3] Sometimes, promotility agents are also used. In most patients with no prior history of heartburn, the reflux resolves after delivery. All the drugs indicated for GERD management in pregnancy are included in the FDA pregnancy B category.[2] Most of them are excreted in breast milk; only H-2 receptor antagonists may be safe to use during lactation.

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