Review Article: The Management of Heartburn in Pregnancy

J.E. Richter


Aliment Pharmacol Ther. 2005;22(9):749-757. 

In This Article


In the first trimester of pregnancy, basal lower oesophageal sphincter (LES) pressure may not change, but is less responsive to physiological stimuli (i.e. pentagastrin, edrophonium chloride, methacholine or a protein meal) that usually increase LES pressure.[1,4] In the later two trimesters, LES pressure gradually falls approximately 33-50% of basal values reaching a nadir at 36 weeks of gestation and rebounds to pre-pregnancy values 1-4 weeks postpartum.[5] Animal and human studies find that the increased circulating levels of progesterone during pregnancy mediate the LES relaxation, but oestrogen is a necessary primer.[1] The secondary role of increased abdominal pressure because of the enlarging gravid uterus is more controversial. All studies agree intra-abdominal pressure increases with pregnancy. It is unknown whether the normal compensatory response of the LES to increase to these changes is impaired during pregnancy.[1] Others have suggested that abnormal gastric emptying or delayed small bowel transit might contribute to heartburn in pregnancy.


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