TREATING GASTROESOPHAGEAL REFLUX DISEASE DURING PREGNANCY AND LACTATION - WHAT ARE THE SAFEST THERAPY OPTIONS

Gastro-oesophageal reflux and heartburn are reported by 45 to 85% of w omen during pregnancy. Typically, the heartburn of pregnancy is new on set and is precipitated by the hormonal effects of estrogen and proges terone on lower oesophageal sphincter function. In mild cases, the pat ient should be reassured that reflux is commonly encountered during a normal pregnancy: lifestyle and dietary modifications may be all that are required. In a pregnant woman with moderate to severe reflux sympt oms, the physician must discuss with the patient the benefits versus t he risks of using drug therapy. Medications used for treating gastro-o esophageal reflux an not routinely or vigorously tested in randomised, controlled trials in women who are pregnant because of ethical and me dico-legal concerns. Safety data are based on animal studies, human ca se reports and cohort studies as offered by physicians, pharmaceutical companies and regulatory authorities. If drug therapy is required, fi rst-line therapy should consist of nonsystemically absorbed medication s, including antacids or sucralfate, which offer little, if any, risk to the fetus. Systemic therapy with histamine H-2 receptor antagonists (avoiding nizatidine) or prokinetic drugs (metoclopramide, cisapride) should be reserved for patients with more severe symptoms. Proton pum p inhibitors are not recommended during pregnancy except for severe in tractable cases of gastrooesophageal reflux or possibly prior to anaes thesia during labour and delivery. In these rare situations, animal te ratogenicity studies suggests that lansoprazole may be the best choice . Use of the least possible amount of systemic drug needed to ameliora te the patient's symptoms is clearly the best for therapy. If reflux s ymptoms are intractable or atypical, endoscopy can safely be performed with conscious sedation and careful monitoring the mother and fetus.