Evidence-based treatment recommendations for gastroesophageal reflux disease during pregnancy: A review

Abstract

Gastroesophageal reflux disease (GERD) occurs in approximately two-thirds of all pregnancies. Around 25% of pregnant women experience heartburn daily. Symptomatic GERD usually presents in the first trimester and progresses throughout pregnancy. The treatment goal is to alleviate heartburn and regurgitation without jeopardizing the pregnancy or its outcome. An English language electronic literature search of MEDLINE, EMBASE, and Cochrane Reviews was undertaken to identify randomized controlled trials, observational studies, management recommendations and reviews of GERD and its treatment during pregnancy. The search period was defined by the date of inception of each database. The treatment in a pregnant GERD patient should follow the step-up approach, starting with lifestyle modification as the first step. If heartburn is severe, medication should be started after consultation with a physician (Recommendation Grade C). The preferred choice of antacids is calcium-containing antacids (Recommendation Grade A). If symptoms persist with antacids Sucralfate can be introduced at a 1g oral tablet, 3 times daily (Recommendation Grade C). Followed by histamine-2 receptor antagonist (Recommendation Grade B). Inadequate control while on histamine-2 receptor antagonist and antacid may mandate a step-up to proton pump inhibitors along with antacids as rescue medication for breakthrough GERD (Recommendation Grade C). This article presented the treatment recommendations for pregnant women with typical GERD, based on the best available evidence.Abbreviations: GERD = gastroesophageal reflux disease, GRADE = grading evidence and strength of recommendation guidelines, H2RA = histamine-2 receptor antagonist, LES = lower esophageal sphincter, PPI = proton pump inhibitor, RCT = randomized clinical trial.

Acid‐suppressive medication and incidence of chronic childhood immune‐mediated diseases: A scoping review

“…While their efficacy in this context is more established, GERD occurs in up to 80% of pregnancies and usually resolves after delivery without complications or long-term effects. [70][71][72] Further, H2RAs and PPIs are considered third-and fourth-line treatment options, respectively, for GERD during pregnancy. 70 Thus, these medications may also be overused in pregnancy.…”

“…[70][71][72] Further, H2RAs and PPIs are considered third-and fourth-line treatment options, respectively, for GERD during pregnancy. 70 Thus, these medications may also be overused in pregnancy. In the face of limited pediatric efficacy for common indications and potential long-term risks, the widespread use of ASMs in pregnancy and early childhood may have important potential public health implications.…”