Review article: the management of heartburn in pregnancy.
Heartburn is a normal consequence of pregnancy. The predominant aetiology is a decrease in lower oesophageal sphincter pressure caused by female sex hormones, especially progesterone. Serious reflux complications during pregnancy are rare; hence upper endoscopy and other diagnostic tests are infrequently needed. Gastro-oesophageal reflux disease during pregnancy should be managed with a step-up algorithm beginning with lifestyle modifications and dietary changes. Antacids or sucralfate are considered the first-line drug therapy. If symptoms persist, any of the histamine2-receptor antagonists can be used. Proton pump inhibitors are reserved for women with intractable symptoms or complicated reflux disease. All but omeprazole are FDA category B drugs during pregnancy. Most drugs are excreted in breast milk. Of systemic agents, only the histamine2-receptor antagonists, with the exception of nizatidine, are safe to use during lactation.
Richter
J E
JE
Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA. jrichter@temple.edu
D000863:Antacids / Q000009:adverse effects / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000009:adverse effects / Q000627:therapeutic use; D020117:Cisapride / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000628:therapy; D005769:Gastrointestinal Motility / Q000187:drug effects; D006356:Heartburn / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006635:Histamine H2 Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007774:Lactation / Q000502:physiology; D008787:Metoclopramide / Q000009:adverse effects / Q000627:therapeutic use; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D054328:Proton Pump Inhibitors; D013392:Sucralfate / Q000009:adverse effects / Q000627:therapeutic use
D000863:Antacids; D000897:Anti-Ulcer Agents; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D013392:Sucralfate; D008787:Metoclopramide; D020117:Cisapride