OB/GYN
A 22-year-old pregnant woman complains of heartburn, which is mainly at night after the dinner when she is…
A 22-year-old pregnant woman complains of heartburn, which is mainly at night after the dinner when she is lying on the bed. She was started on antacid syrup with somewhat response to that. She denies history of abdominal pain or nausea. Which of the following is the best next step in the management?
Explanation
Core Concept: Gastroesophageal Reflux Disease (GERD) in Pregnancy. Common due to progesterone-induced lower esophageal sphincter relaxation and mechanical compression by the gravid uterus.
Clinical Presentation:
- Heartburn, acid regurgitation, especially postprandial or when supine.
Diagnosis:
- First-line: Clinical diagnosis based on typical symptoms.
- Gold Standard: Upper endoscopy is rarely needed unless alarm symptoms (dysphagia, weight loss, bleeding) are present.
Management:
- Acute: Step-up approach starting with dietary and lifestyle modifications (small frequent meals, avoiding eating before bedtime, elevating the head of the bed).
- Definitive: If lifestyle modifications and simple antacids fail, H2-receptor antagonists (e.g., famotidine) or PPIs (e.g., pantoprazole) are safe and effective in pregnancy. Reinforcing lifestyle modifications is the most appropriate foundational next step before escalating pharmacotherapy.