heartburn in pregnancy

Heartburn in Pregnancy / Acid Reflux


Heartburn during pregnancy – Heartburn Diet

KNOW THE CAUSE OF HEARTBURN IN PREGNANCY /SYMPTOMS OF HEARTBURN IN PREGNANCY/ DIAGNOSIS OF HEARTBURN IN PREGNANCY / TIPS TO PREVENT HEARTBURN IN PREGNANCY / TREATMENT

What is HEARTBURN IN PREGNANCY

Heartburn also known as Acid reflux. Occurs when the acid that is normally in your stomach backs up into your esophagus . The esophagus is the tube that carries food from your mouth to your stomach. Another term for acid reflux is “gastroesophageal reflux disease” or GERD.

Many women get heartburn in pregnancy. Acid reflux / heartburn usually gets worse over the course of the pregnancy. It usually goes away after the baby is born.

Women who have acid reflux in one pregnancy are likely to get it again in future pregnancies.

What are the symptoms of acid reflux or Heartburn in pregnancy? — 

The most common symptoms of acid reflux during pregnancy are:

●Burning in the chest, known as heartburn

●Burning in the throat or an acid taste in the mouth

●Stomach or chest pain

●Nausea or vomiting

●Trouble swallowing

●A raspy voice or sore throat

● Cough

These symptoms may be present from first to third trimester.

WHY HEARTBURN IN PREGNANCY OCCURS ?

Heartburn / acid reflux happens due to mechanical ( growing uterus ) and intrinsic factors (female hormones ) which affect the lower esophageal sphincter tone.

( Lower esophageal sphincter is like a valve at lower end of food pipe which prevents food from regurgitating food from stomach to food pipe )

The Esophagus (Human Anatomy): Picture, Function, Conditions, and More
LOWER ESOPHAGEAL SPHINCTER

Lower esophageal sphincter pressure is below the lower limits of normal in all trimesters, returning to normal in the postpartum period.

Some studies have shown that female hormones ( estradiol and progesterone ) decreases the tone of lower esophageal sphincter.

In addition, during the later months of pregnancy, your growing
uterus continually pushes on your stomach, moving it higher and compressing it. This pressure can force stomach acids upward, causing heartburn.

Will I need tests for heartburn in pregnancy ? — Probably not. Your doctor or nurse should be able to tell if you have it by talking with you and doing an exam.

When should I call my doctor or nurse? — Call your doctor or nurse if you:

●Have severe heartburn or chest pain, or these symptoms don’t get better with treatment

●Have a fever, headache, nausea, or vomiting with your heartburn

●Choke when you eat, have trouble swallowing, or feel like food is getting “stuck” on the way down your throat

●Lose weight without trying

●Vomit bright red blood or material that looks like coffee grounds

●Have bowel movements that look like black tar

Upper endoscopy should be performed during pregnancy only if there is a strong indication (eg, significant gastrointestinal bleeding).

When possible, endoscopy should be postponed until the second trimester.

Is there anything I can do on my own to improve my symptoms? — Yes. To help with your symptoms, you can :

  • Eat more-frequent but smaller meals. For example, have five or six small meals a day rather than three large meals.
  • Avoid foods that are more likely to irritate your stomach and esophagus than are others. Determine which foods give you heartburn, and avoid them. Stay away from fatty, greasy or fried foods, coffee and tea, chocolate, peppermint,alcohol, carbonated beverages, very sweet foods, acidic foods such as citrus fruits and juices, tomatoes and red peppers, and highly spiced foods.
  • Drink plenty of fluids : especially water.
  • Sit with good posture when eating: Slouching can put extra pressure on your stomach.
  • Wait an hour or longer after eating before you lie down.
  • Avoid eating for two to three hours before you go to bed: An empty stomach produces less acid.
  • Avoid movements and positions that seem to aggravate the problem :When picking things up, bend at the knees, not the waist.
  • When resting or sleeping, prop yourself up on pillows to elevate your head and shoulders, or raise the head of your bed four to six inches.

Are there treatments for heartburn in pregnancy that can help reduce symptoms? — 

Yes. There are 4 main types of medicines that can reduce acid reflux symptoms. They are:

Antacids

Surface agents

Histamine blockers

Proton pump inhibitors

All of these medicines work by reducing or blocking stomach acid.

Initial management of gastroesophageal reflux disease (GERD) / acid reflux / heartburn in pregnancy consists of lifestyle and dietary modification (eg, elevation of the head end of the bed, avoidance of dietary triggers).

ALSO READ : https://www.thedoctips.com/do-you-feel-heartburn-or-acid-reflux-know-about-gastroesophageal-reflux-disease/

In patients with persistent symptoms, pharmacologic therapy should begin with antacids followed by Sucralfate.

In patients who fail to respond, similar to nonpregnant patients, histamine 2 receptor antagonists and then proton pump inhibitors (PPIs) should be used to control symptoms.

ANTACIDS FOR HEARTBURN IN PREGNACNY :

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 Antacids usually contain a combination of magnesium trisilicate , aluminium hydroxide and calcium carbonate which neutralize gastric pH, thereby decreasing the exposure of the esophageal mucosa to gastric acid during episodes of reflux.

Antacids begin to provide relief of heartburn within five minutes, but have a short duration of effect of 30 to 60 minutes. 

Most antacids are considered safe in pregnancy and are compatible with breastfeeding .

However, antacids containing sodium bicarbonate and magnesium trisilicate should be avoided in pregnancy

SURFACE AGENTS FOR HEARTBURN IN PREGNANCY :

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 SUCRALFATE is likely safe during pregnancy and lactation because it is poorly absorbed .

In patients who continue to have symptoms of GERD despite antacids, advised sucralfate (1 g orally three times daily).

HISTAMINE 2 RECEPTOR ANTAGONISTS FOR HEARTBURN IN PREGNANCY : (H2RA)

While all Histamine 2 receptor blockers appear to be safe in pregnancy, in patients with continued GERD symptoms on sucralfate, Ranitidine and cimetidine is suggested as they have the most safety data available .

Ranitidine and cimetidine are concentrated in breast milk, but are compatible with breastfeeding.

PROTON PUMP INHIBITORS FOR HEARTBURN IN PREGNANCY : (PPI)

 PPIs are probably safe in pregnancy . Limited data are available on the secretion of PPIs in breast milk. 

Omeprazole and pantoprazole are secreted in low concentrations in breast milk .

However, most of this is likely destroyed by gastric acid in the infant’s stomach .

In pregnant patients with GERD symptoms despite H2RAs, we suggest the use of omeprazole, lansoprazole or pantoprazole rather than other PPIs, as they have been more widely used in pregnancy.

MedicationLow dose (adult, oral)Standard dose (adult, oral)
Histamine 2 receptor antagonists
Famotidine10 mg twice daily20 mg twice daily
Ranitidine75 mg twice daily150 mg twice daily
Nizatidine75 mg twice daily150 mg twice daily
Cimetidine200 mg twice daily400 mg twice daily
Proton pump inhibitors
Omeprazole20 mg daily40 mg daily
Lansoprazole15 mg daily30 mg daily
Esomeprazole20 mg daily40 mg daily
Pantoprazole20 mg daily40 mg daily
DexlansoprazoleNot available30 mg daily, 60 mg daily
Rabeprazole10 mg daily20 mg daily
DRUGS IN GERD / HEARTBURN

ALSO READ :https://www.medicinenet.com/pregnancy/article.htm

CONCLUSION FOR HEARTBURN IN PREGNANCY :

Heartburn also known as Acid reflux. Occurs when the acid that is normally in your stomach backs up into your esophagus .

Heartburn / acid reflux happens due to mechanical ( growing uterus ) and intrinsic factors (female hormones ) which affect the lower esophageal sphincter tone.

Initial management of gastroesophageal reflux disease (GERD) / acid reflux / heartburn in pregnancy consists of lifestyle and dietary modification (eg, elevation of the head end of the bed, avoidance of dietary triggers).

There are 4 main types of medicines that can reduce acid reflux symptoms. They are:

Antacids

Surface agents

Histamine blockers

Proton pump inhibitors

All of these medicines work by reducing or blocking stomach acid.

In patients with persistent symptoms, pharmacologic therapy should begin with antacids followed by Sucralfate.

In patients who fail to respond, similar to nonpregnant patients, histamine 2 receptor antagonists and then proton pump inhibitors (PPIs) should be used to control symptoms.