Acid Reflux, GERD and Heartburn in Pregnancy

Normally the acidic contents of the stomach remain within the stomach and pass out into the neighboring duodenum (first part of the small intestine) in small quantities. The stomach has mechanisms to withstand the highly corrosive acid and the small intestine has its own mechanisms to neutralize the acids. It is abnormal for stomach acid to enter the esophagus and backward flow of stomach contents into the esophagus is prevented by the action of the lower esophageal sphincter (LES). Food that enters the mouth passes down the throat and into the esophagus where the LES opens in a controlled manner to allow it to pass into the stomach.

Sometimes the acidic stomach contents flows backwards into the esophagus where it cause severe irritation of the delicate inner lining of the esophagus. This acid reflux is felt as a burning chest pain known as heartburn. It is usually acute and can be easily treated and may then never occur again. However, sometimes there is ongoing reflux irrespective of the usual trigger factors. Acid reflux is more correctly known as gastroesophageal reflux disease (GERD), although the latter term is usually used to refer to the more chronic state.

 Causes of Acid Reflux

Acid reflux is the main cause of heartburn but the burning chest pain can sometimes be related to other causes that may not involve the gastrointestinal tract. Heartburn and cardiac pain are often mistaken for one another and it is not uncommon for a person with severe heartburn to present at the emergency room believing that they are having a heart attack. While this is not common in youngerwomen, the risks is nevertheless present and more so in older women and those with a history of heart disease.

Most cases of acid reflux in pregnancy are acute – it arises in pregnancy and resolves soon after childbirth. However, women with a history of reflux, even prior to pregnancy, are likely to experience an exacerbation during pregnancy with the condition persisting after childbirth unless suitable treatment is initiated. Acid reflux is largely due to a dysfunctional lower esophageal sphincter but may also occur with delayed gastric emptying and increased intra-abdominal pressure. In pregnant, the expanding uterus increases the intra-abdominal pressure, pushes against the stomach and the higher than normal levels of female hormones affects normal upper gastrointestinal motility and the functioning of the lower esophageal sphincter.

The condition is more likely to be worse after eating a heavy meal, when lying down or with the intake of alcohol or cigarette smoking, both of which should be stopped during pregnancy. It may also be exacerbated by strenuous physical activity, bending over and with emotional upset.

Symptoms of Acid Reflux

Heartburn is a symptom of acid reflux and not a disease on its own. Other signs and symptoms may be present including :

  • Nausea
  • Regurgitation
  • Upper middle abdominal pain
  • Sour taste in the mouth
  • Sore throat particularly in the morning that eases during the course of the day.

Sometimes reflux is asymptomatic and is then referred to as silent reflux disease.

Medication for Reflux in Pregnancy

Reflux, like any disease or symptom in pregnancy, should be managed conservatively as far as possible. Dietary change and avoiding trigger factors are the first step that a pregnant women should undertake. Sleeping slightly elevated and avoiding eating for at least 2 to 3 hours before bedtime should also be considered. Never use any antireflux medication without first consulting with a medical practitioner. Some of these medication may have adverse effects in pregnancy. Antacids, sucralfates and H2-antagonists can be used during pregnancy. While proton pump inhibitors may be used, it should utilized cautiously or avoided altogether as with H2-antagonists in the first trimester of pregnancy.

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