Review Article: The Management of Heartburn in Pregnancy

J.E. Richter

Disclosures

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

In This Article

Diagnosis in the Pregnant Patient

As in the non-pregnant patient, the initial diagnosis of GERD in pregnancy can reliably be made based on symptoms alone.[6] Barium radiographs are not necessary and should be avoided because of radiation exposure to the fetus. Oesophageal manometry and pH studies are rarely necessary during pregnancy but can be performed safely. Upper gastrointestinal (GI) endoscopy is the procedure of choice to evaluate intractable reflux symptoms or complications. This procedure can be safely performed without harm to the mother or fetus by carefully monitoring blood pressure and oxygen and judicious use of conscious sedation and fetal monitoring.[2,7,8] Midazolam and diazepam are category D, fentanyl is category C and meperidine and propofol are category B drugs during pregnancy ( Table 1 ). Although not approved by the FDA for these indications during pregnancy, clinical experience suggests that these medications are safe with appropriate monitoring, particularly after the first trimester.[7,8]

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