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Review article: the management of heartburn in pregnancy Richter JEAliment Pharmacol Ther 2005[Nov]; 22 (9): 749-57Heartburn 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.|Antacids/adverse effects/therapeutic use[MESH]|Anti-Ulcer Agents/adverse effects/therapeutic use[MESH]|Cisapride/adverse effects/therapeutic use[MESH]|Female[MESH]|Gastroesophageal Reflux/drug therapy/therapy[MESH]|Gastrointestinal Motility/drug effects[MESH]|Heartburn/drug therapy/physiopathology/*therapy[MESH]|Histamine H2 Antagonists/adverse effects/therapeutic use[MESH]|Humans[MESH]|Lactation/physiology[MESH]|Metoclopramide/adverse effects/therapeutic use[MESH]|Pregnancy[MESH]|Pregnancy Complications/drug therapy/physiopathology/*therapy[MESH]|Proton Pump Inhibitors[MESH]|Sucralfate/adverse effects/therapeutic use[MESH] |
