Gastroesophageal reflux disease and pregnancy

Gastroesophageal reflux disease (GERD) is a chronic relapsing disease caused by a violation of the motor and evacuation function of the gastroesophageal zone and characterized by a spontaneous or regularly repeated throwing into the esophagus of gastric or duodenal contents, which leads to damage to the distal esophagus with the development of erosive-ulcerative, catarrhal and / or functional disorders.

ICD-10 code

• K 21.0 - Gastroesophageal reflux with esophagitis
• K 21.9 - Gastroesophageal reflux without esophagitis.

Epidemiology

Epidemiology of gastroesophageal reflux disease in pregnancy

Heartburn, the main symptom of gastroesophageal reflux disease, occurs in about 50% of pregnant women, reaching 80% from the results of individual studies. Heartburn so often worries pregnant women that both the patients themselves and many midwives consider it a normal manifestation of pregnancy, not requiring special attention.

The body mass index before pregnancy, weight gain during the latter, the race does not affect the incidence and severity of the symptom. The development of heartburn in the first pregnancy increases the risk of its recurrence at subsequent ones.

Often, heartburn is a consequence of exacerbation of the previously existing GERD. Our experience shows that out of 55 pregnant women with reflux esophagitis, confirmed endoscopically, only 10 (18.2%) had a disease for the first time in their life during pregnancy. There is also a point of view that most women start complaining of heartburn only when it actually worsens the quality of life, brings considerable anxiety, i.e. Much later than it actually appears.

[1], [2], [3], [4], [5], [6]

Symptoms of the gastroesophageal reflux disease in pregnancy

Symptoms of gastroesophageal reflux disease in pregnancy

Symptoms of gastroesophageal reflux disease during pregnancy practically does not differ from that outside of it. The main symptom is heartburn, which usually develops after eating, especially after consuming abundant, fatty, fried and spicy food. Some women, in order to avoid the appearance of heartburn, prefer to eat once a day, which can lead to a significant loss of body weight. The heartburn lasts from several minutes to hours, repeats repeatedly several times a day, amplifying in a horizontal position, when turning from one side to the other. Some pregnant women pay attention to the fact that heartburn worries more on the left side. In addition, the torso of the body forward, for example, to put on or fasten the shoes (a symptom of the "lace"), provoke its appearance.

In a number of cases, in order to relieve heartburn that arises during the night during sleep, the patient is forced to stand up, walk around the room for a while, drink water. Some women have to sleep sitting in a chair. The feeling of heartburn is accompanied by a painful feeling of melancholy, a depressed mood. Against the background of prolonged heartburn, there may be pains on the sternum, solitary phlegm, belching of the air. Often the pain radiates to the nape, interlopar space, increases during or immediately after eating. Sometimes salivary discharge increases in patients with heartburn.

Gastroesophageal reflux disease in pregnancy - Symptoms

Forms

Classification of gastroesophageal reflux disease in pregnancy

In 2002, at the World Congress of Gastroenterologists in Los Angeles, a new clinical classification of gastroesophageal reflux disease was adopted, according to which the following are distinguished:

• non-erosive (or endoscopically negative) form of the disease (NERD), i.e. GERD without signs of esophagitis; this definition extends to those cases when the patient with manifestations of the disease, especially heartburn, which meet the clinical criteria of gastroesophageal reflux disease, had no damage to the mucosa of the esophagus;
• erosive-ulcerative (or endoscopically positive) form of the disease, including complications in the form of ulcers, esophageal strictures;
• Barrett's esophagus (metaplasia of multilayered planar epithelium in the cylindrical in the distal esophagus as a consequence of gastroesophageal reflux disease.The isolation of this form of the disease is due to the fact that this form of metaplasia is considered to be a precancerous state.Today, cases in pregnant women are not described in the literature).

[7], [8], [9], [10], [11]

Diagnostics of the gastroesophageal reflux disease in pregnancy

Screening

Does not exist.

Diagnosis of gastroesophageal reflux disease in pregnancy

Diagnosis of GERD during pregnancy is established on the basis of complaints, data of anamnesis, and also results of instrumental examination.

X-ray examination due to possible damaging effects on the fetus in pregnant women is not applied, pH-metry can be used, but the need for its use is questionable.

Esophagogastroduodenoscopy (EGDS) is a method of choice for the diagnosis of GERD (gastroesophageal reflux disease), especially its complications. Although the method is burdensome for the mother, but its safety for the fetus, high information content, the ability to accurately diagnose and differential diagnosis of diseases, put him on the 1 st place among the instrumental methods for diagnosing the pathology of the upper digestive tract in pregnant women. Having started using endoscopy in urgent situations, we came to the conviction that it is necessary to use it in a planned examination of pregnant women who have appropriate indications.

Gastroesophageal reflux disease in pregnancy - Diagnosis

[12], [13], [14], [15], [16], [17]

Treatment of the gastroesophageal reflux disease in pregnancy

Treatment of gastroesophageal reflux disease in pregnancy

The basis of therapeutic measures for GERD (heartburn) is the maximum strengthening of the factors of protection from reflux and the weakening of the aggressive acid-peptic factor, which must begin with the observance of recommendations on changing the lifestyle and diet.

A woman should avoid those provisions that contribute to the occurrence of heartburn. In the absence of contraindications - a dream with a raised head end of the bed (it should be raised at an angle of 15 °, one "high" pillows is not enough). Extremely long stay in an inclined position, forced position in bed with a lowered headboard, performance of gymnastic exercises connected with the tension of the abdominal press, wearing tight belts, corsets are highly undesirable. It is necessary to avoid constipation if it develops, since any straining leads to an increase in intra-abdominal pressure, throwing acidic gastric contents into the esophagus, and the appearance of heartburn.

After eating, do not go to bed - it's better to sit or even stand: this facilitates more rapid evacuation of food from the stomach.

Gastroesophageal reflux disease in pregnancy - Treatment

Prevention

Prevention of gastroesophageal reflux disease in pregnancy

It consists in observing general "regime" and dietary measures designed for patients suffering from GERD.