Gastroesophageal reflux disease occurs in up to 50% of pregnant women. As in the non-pregnant patients, reflux occurs when there is a decrease in lower esophageal sphincter pressure or an increase in intra-abdominal pressure. The two major factors that promote gastroesophageal reflux in pregnant women are changes in hormones and the growing fetus. Changes in levels of estrogen and progesterone result in a decrease in the lower esophageal sphincter pressure thereby increasing acid reflux. Additionally, the growing fetus causes an increase in intra-abdominal pressure, resulting in an increase in the development of reflux.
What can be done to prevent or treat gastroesophageal reflux disease in pregnancy? Lifestyle modifications can prevent increases in intra-abdominal pressure and decreases in lower esophageal sphincter pressure that promote reflux. Here's a list of both ways to prevent and treat gastroesophageal reflux in pregnancy.
1. Elevation of the head of the bed. Gravity plays an important role in controlling reflux. When a person is recumbent, stomach contents are more likely to reflux into the esophagus. Studies have documented that, as compared with patients who sleep flat on their backs, patients who elevate the head of the bed have significantly fewer reflux episodes, and when they do, the episodes that do occur are shorter and produce generally milder symptoms.
2. Lying on one's left side at night. Sleeping on the left side as opposed to the right side may reduce the frequency and duration of reflux episodes in patients prone to symptoms during the night. It is felt that there are more frequent episodes of decreases in lower esophageal sphincter pressure when patients lie on the left side as opposed to the right side.
3. Avoiding caffeine, chocolate and peppermints. These food groups all lead to a decrease in lower esophageal sphincter pressure. (For more diet suggestions to help ease reflux click here.)
4. Chewing gum. This increases saliva production and swallowing frequency, which can help clear away acid that has refluxed from the stomach into the esophagus. A clear reduction in acidic esophageal reflux has been documented in patients who chewed sugar-free gum for 30 minutes after a meal.
5. Eating frequent, small meals. Eating smaller meals empties the stomach more rapidly. Eating more frequently increases stomach contractions. If the stomach is contracting and empty this will decrease the incidence of reflux.
6. Antacids such as Mylanta and Maalox are effective and very safe as they are not absorbed into the bloodstream.
7. H2 blockers Zantac, Pepcid and Tagamet are effective. While they are absorbed into the bloodstream, studies have not revealed any adverse effects on the developing fetus.
8. Proton pump inhibitors Nexium, Aciphex and Prevacid should be used only in severe cases that are not responsive to H2 blockers. While they are felt to be safe, there are no long-term studies available confirming this.
In most cases, acid reflux is easily treated, even in pregnancy. If there are however, more refractory symptoms that result in complications such as gastrointestinal bleeding, difficulty swallowing or weight loss, your obstetrician may refer you to a gastroenterologist. Other conditions such as gallbladder disease, pancreatitis or even cancers of the esophagus and stomach can mimic gastroesophageal reflux disease.