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🔥+ Gerd knabe 09 Aug 2020 GERD occurs when the upper portion of the digestive tract is not functioning properly, causing ... Common trigger foods include alcohol, caffeine, fatty foods, and some spices. ... To reduce nighttime symptoms, elevating the head of the bed about six inches may also help, but make sure to do this by ... Send email Mail.

Gerd knabe Use These Food Clues to Find the Cause of Heartburn Symptoms ... fruits are highly acidic, and heartburn symptoms can stem from having too much acid in your ... And remember that tea and many soft drinks also have caffeine, so you may want to ... "It's typical for alcohol to trigger heartburn," Lamm says.

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Heartburn is a manifestation of the reflux of gastric contents into the esophagus and, as its name suggests, is described as being a hot sensation behind the sternum or in the left parasternal area.

From: Brocklehurst's Textbook of the 1 last update 09 Aug 2020 Geriatric Medicine and Gerontology (Seventh Edition), 2010Brocklehurst's Textbook of Geriatric Medicine and Gerontology (Seventh Edition), 2010

Related terms:

Heartburn

William the 1 last update 09 Aug 2020 A. SodemanJr. M.D., J.D., F.A.C.P., F.A.C.G., F.A.C.L.M., Thomas C. Sodeman M.D., in Instructions for Geriatric Patients (Third Edition), 2005William A. SodemanJr. M.D., J.D., F.A.C.P., F.A.C.G., F.A.C.L.M., Thomas C. Sodeman M.D., in Instructions for Geriatric Patients (Third Edition), 2005

Gerd knabe Nighttime (👍 Foods To Avoid) | Gerd knabe Chronic Heartburnhow to Gerd knabe for
General Information

Heartburn is a common problem. One fifth of adults in the United States have occasional heartburn, and 10% suffer daily attacks. With aging, changes occur in the ability of the esophagus, the swallowing tube that leads from the mouth to the stomach, to work smoothly. There is an associated increase in the occurrence of heartburn as one grows older.

The symptom of heartburn is usually a warm or burning feeling in the middle of the front of the chest. Bending, straining, or stooping often causes heartburn, and it is frequently worse when one lies down. Food or drink can relieve the burning sensation, as does the use of an antacid preparation. Such relief is temporary, because the problem is recurrent. Often particular foods cause heartburn. Icing on rolls or cake, orange juice, hot (spicy) foods, and hot dogs are common causes. Any individual may have a particular food that brings on the problem, although it may not be the same food that bothers other sufferers. A few patients with severe heartburn experience the regurgitation of food and acid into the mouth and throat. Sometimes they are aware of this only as a bitter taste in the mouth on awakening in the morning. On other occasions it is very apparent, producing irritation with coughing and choking.

Nighttime regurgitation while asleep can occur and occasionally permits acid or food to get into the windpipe. This can cause hoarseness and cough that on occasion is the only complaint related to the reflux. In some individuals this provokes wheezing and shortness of breath resembling asthmatic attacks. Acid coming up into the mouth at night may be the cause of erosion of the teeth. These complications may occur without the occurrence of heartburn.

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Heartburn

Richard E. Sampliner MD, in Decision Making in Medicine (Third Edition), 2010

A.

Gerd knabe Heartburn Relief Foods (☑ Home Remedy) | Gerd knabe To Eathow to Gerd knabe for Gerd knabe Without Medication (⭐️ Acid Reflux Remedies) | Gerd knabe Breakfast Forhow to Gerd knabe for for 1 last update 09 Aug 2020 HeartburnHeartburn is the leading symptom of gastroesophageal reflux disease (GERD). It is a substernal sensation of burning that radiates orad and usually reflects the presence of gastric content in the esophagus.

B.

Proton pump inhibitor (PPI) therapy is the most effective kind of therapy to relieve symptoms of GERD. At the same time PPI therapy is effective in healing the erosive esophagitis that occurs in a minority of patients who present with heartburn.

C.

Step-down treatment is a way to define the lowest level of therapy that will provide symptom relief for a patient. The dose of PPI maybe reduced to every other day, or an H2-receptor antagonist may be initiated.

D.

The alarm symptoms and signs of GERD include dysphagia (difficulty swallowing), weight loss, and anemia. These findings warrant immediate endoscopy to look for complications that need prompt attention, such as esophageal stricture, esophageal ulcer, and cancer.

E.

Most patients with GERD have satisfactory symptom control with PPI therapy; a subgroup require twice-daily dosing.

F.

Maintenance PPI therapy is whatever dose of PPI that controls the patient's symptoms. It is often necessary to maintain a PPI indefinitely in order to control the symptoms and mucosal disease of the patient with GERD. It is important to recognize that the contemporary indication for laparoscopic fundoplication is not the failure of medical therapy but rather the symptomatic response of the patient to a PPI. Patients who are maintained on a PPI with relief but who still have residual regurgitation indicating volume reflux are appropriate candidates for laparoscopic fundoplication.

G.

Initiate 24-hour pH monitoring for patients who fail PPI twice-daily therapy. The goal is to see if there is still abnormal distal esophagus acid exposure. The majority of patients will in fact have a normal 24-hour pH study. However, if the duration of low pH in the distal esophagus is still elevated, an increased the 1 last update 09 Aug 2020 dosing of the PPI is appropriate.Initiate 24-hour pH monitoring for patients who fail PPI twice-daily therapy. The goal is to see if there is still abnormal distal esophagus acid exposure. The majority of patients will in fact have a normal 24-hour pH study. However, if the duration of low pH in the distal esophagus is still elevated, an increased dosing of the PPI is appropriate.

H.

Upper endoscopy is a consideration in any patient with chronic heartburn. Even if the patient's symptoms are controlled with a PPI, the duration of heartburn should be counted for 1 last update 09 Aug 2020 from the onset of reflux symptoms through the course of PPI therapy. Patients most likely to have Barrett's esophagus, according to our current understanding, include older white males with chronic reflux. Unfortunately, we now recognize that a significant group of patients with Barrett's esophagus lack reflux symptoms.Upper endoscopy is a consideration in any patient with chronic heartburn. Even if the patient's symptoms are controlled with a PPI, the duration of heartburn should be counted from the onset of reflux symptoms through the course of PPI therapy. Patients most likely to have Barrett's esophagus, according to our current understanding, include older white males with chronic reflux. Unfortunately, we now recognize that a significant group of patients with Barrett's esophagus lack reflux symptoms.

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Nutrition in the Prevention and Treatment of Common Gastrointestinal Symptoms

LAWRENCE J. CHESKIN, DEBRA L. MILLER, in Nutrition in the Prevention and Treatment of Disease, 2001

A. Prevalence and Causes

Gerd knabe Anti-Reflux Diet (☑ 9 Home Remedies) | Gerd knabe 12 Tipshow to Gerd knabe for Heartburn is the most common specific gastrointestinal complaint in the Western Hemisphere. Nearly every middle-aged American adult has had one or more episodes of heartburn. Surveys have found that about 40% of U.S. adults experience heartburn at least once a month [17, 18], while roughly 10% suffer with heartburn daily [19]. Heartburn is also common during pregnancy, particularly in the third trimester, with 90% of pregnant women experiencing some type of reflux symptoms [20].

Gastroesophageal reflux disease (GERD) occurs when the muscle connecting the esophagus with the stomach does not function properly, allowing stomach acids and contents to enter the esophagus. Heartburn begins as a burning pain that starts behind the breastbone and radiates upward toward the back of throat. The description of “burning” or “hot” or “acidic” sensations is typically used. Often there is a sensation of food coming back into the mouth, accompanied by an acid or bitter taste. Heartburn can become intense enough to cause pain that radiates throughout the chest region upward toward the neck and throat and occasionally to the back and arms.

Heartburn, the classic manifestation of GERD, is a commonly used but frequently misunderstood term. It has many synonyms, including “indigestion,” “acid regurgitation,” “sour stomach,” and the more general “chest pain.” The precise physiologic mechanisms that produce heartburn are, surprisingly, poorly understood. Although the reflux of gastric acid is most commonly associated with heartburn, the same symptoms may be elicited by other gastrointestinal events (esophageal distention, reflux of bile salts, and acid-induced motility disorders).

The pain associated with heartburn seems best explained by the stimulation of chemoreceptors due to the sensitivity of the esophagus to the presence of acid, as demonstrated during perfusion studies or by monitoring the esophageal pH of people with GERD. These receptors, however, are not superficial and their specific location is not known [21]. Correlations between discrete episodes of acid reflux and actual pain are poor; therefore, painful symptoms seem to require more than just the presence of acid in the esophagus [22]. One contributing factor may be the disruption of the mucous membrane in the esophagus, although most symptomatic patients do not show such a disruption. Another possibility is hydrogen ion concentrations in the esophagus that alter its pH. One study found that 25 participants with reflux disease experienced heartburn-like symptoms when infused with solutions of pH 1.0 and 1.5, but only one-half had such symptoms with solutions of pH 2.5–6.0 [23]. Other factors may include inflammation with increased polymorphonuclear leukocytes, acid clearance mechanisms, salivary bicarbonate concentration, volumes of refluxed acid, and the interaction of pepsin with acid [5].

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Structural reflex zone therapy for pregnancy

Denise Tiran MSc, PGCEA, RM, RGN, ADM, ... Maggie Evans RM, RN, HV Cert, MSc (Complementary for 1 last update 09 Aug 2020 Therapies), in Reflexology in Pregnancy and Childbirth, 2010Denise Tiran MSc, PGCEA, RM, RGN, ADM, ... Maggie Evans RM, RN, HV Cert, MSc (Complementary Therapies), in Reflexology in Pregnancy and Childbirth, 2010

Structural physiology and aetiology

Gerd knabe Doesn't Help (☑ Foods To Avoid) | Gerd knabe 9 Natural Remedieshow to Gerd knabe for Heartburn, indigestion and acid reflux all commonly occur in pregnancy, usually in the latter stage, although they may also accompany first trimester nausea and vomiting. Symptoms are largely due to the effects of progesterone, which relaxes the cardiac sphincter of the stomach, causing acid reflux. It is worse in women with multiple pregnancy and when the fetal presentation is breech, due to upwards pressure on the diaphrgam. Some mothers may experience a burning sensation at varying levels in the oesophagus, which will usually correspond to tender areas on the oesophagus reflex zones of the feet, relative to the level of heartburn. Mechanical distress also occurs at the junction of the oesophagus, cardiac sphincter and stomach due to changes within the abdominal/uterine cavities, the spinal kyphosis/lordosis and the inter-relationship between the shoulder and pelvic girdles. Heartburn is also often exacerbated by the weight of the breasts, particularly if the mother wears an ill-fitting brassiere, or if her general posture is poor with an accentuated thoracic kyphosis.

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Western approach to for 1 last update 09 Aug 2020 pregnancyWestern approach to pregnancy

Suzanne Yates BA(Hons) DipHSEC MRSS(T) APNT PGCE(PCET), in Pregnancy and Childbirth, 2010

Heartburn

for 1 last update 09 Aug 2020 HeartburnHeartburn affects about 30–70% of women. It is worse with multiple pregnancies, polyhydramnios (excess amniotic fluid), obesity and with excessive bending. Often simply eating sitting upright, as opposed to slouching, can make a difference. Alcohol, coffee and chocolate all exacerbate heartburn by reducing muscle tone. Gastric reflux can be reduced by advising more frequent intake of smaller meals and avoidance of seasoned food. Many women take antacid preparations but these can have side-effects such as:

Aluminium salts – diarrhoea.

Magnesium salts – constipation.

Phosphorus may affect calcium/phosphorus balance and exacerbate cramp.

Sodium may affect water balance.

Gerd knabe Disease (🔥 Diet For) | Gerd knabe Home Remedieshow to Gerd knabe for Long-term use of antacids is associated with malabsorption, particularly of drugs and dietary minerals.

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Gerd knabe Natural Remedies (⭐️ Home Remedies For) | Gerd knabe How To Get Rid Ofhow to Gerd knabe for Gastroesophageal Reflux Disease

Peter R. McNally DO, in GI/Liver Secrets (Fourth for 1 last update 09 Aug 2020 Edition)GI/Liver Secrets (Fourth Edition), 2010

2 What are the typical symptoms of GERD?

Gerd knabe Causes (👍 Side Effects) | Gerd knabe 14 Home Remedieshow to Gerd knabe for Heartburn is usually characterized as a midline retrosternal burning sensation that radiates to the throat and occasionally to the intrascapular region. Patients often place the open hand over the sternal area and flip the wrist in an up-and-down motion to simulate the nature and location the 1 last update 09 Aug 2020 of the heartburn symptoms. Mild symptoms of heartburn are often relieved within 3 to 5 minutes of ingesting milk or antacids. Other symptoms of GERD include the following:Heartburn is usually characterized as a midline retrosternal burning sensation that radiates to the throat and occasionally to the intrascapular region. Patients often place the open hand over the sternal area and flip the wrist in an up-and-down motion to simulate the nature and location of the heartburn symptoms. Mild symptoms of heartburn are often relieved within 3 to 5 minutes of ingesting milk or antacids. Other symptoms of GERD include the following:

Gerd knabe Best Drinks For (⭐️ Natural Heartburn Remedies) | Gerd knabe 14 Home Remedieshow to Gerd knabe for Regurgitation consists of eructation of gastric juice or stomach contents into the pharynx and often is accompanied by a noxious bitter taste. Regurgitation is most common after a large meal and usually occurs with stooping or assuming a recumbent posture.

Dysphagia (difficulty in swallowing) usually is caused by a benign stricture of the esophagus in patients with longstanding GERD. Solid foods, such as meat and bread, are often precipitants of dysphagia. Dysphagia implies significant narrowing of the esophageal lumen, usually to a luminal diameter of less than 13 mm. Prolonged dysphagia, associated with inability to swallow saliva, requires prompt evaluation and often endoscopic removal (see Chapter 61, Fig. 61-1).

Water brash is an uncommon symptom but highly suggestive of GERD. Patients literally foam at the mouth as the salivary glands produce up to 10 mL of saliva per minute as an esophagosalivary reflex response to acid reflux.

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Integrative Strategies During Pregnancy

Gerd knabe Tips (🔥 Doesn't Help) | Gerd knabe Treat GERDhow to Gerd knabe for Tieraona Low Dog MD, in Women's Health in Complementary and Integrative Medicine, 2005

GASTROESOPHAGEAL REFLUX

Heartburn can occur during pregnancy because of increased progesterone reducing the tone of the cardiac (gastroesophageal) sphincter. The refluxing stomach acids irritate the lining of the esophagus, causing heartburn. Hiatal hernias are common in the general population and occur in approximately 20% of pregnant women. Reflux results as a portion of the stomach protrudes above the diaphragm, preventing the proper closure of the cardiac sphincter.

Women should be encouraged to eat small, frequent meals; refrain from eating close to bedtime; and avoid tight-fitting clothes around the abdomen. Some women find it helpful to elevate the head of the bed. Foods and substances that increase stomach acidity or reduce cardiac sphincter tone should be avoided, including cigarettes, alcohol, coffee, peppermint, and chocolate.

Botanicals

A number of herbs are used to soothe esophageal irritation, including several that are safe for use in pregnancy. Two herbs that are readily available are chamomile (Matricaria recutita) and marshmallow (Althaea officinalis). No significant clinical research has been conducted to evaluate the effectiveness of chamomile teas or extracts for the treatment of gastrointestinal inflammation; however, the herb is widely accepted for this purpose by many authorities. Animal studies have shown that oral administration of (-)-α-bisabolol reduces gastric toxicity induced by acetylsalicylic acid19 and inhibits the development of ulcers caused by indomethacin, ethanol, and stress.20 Chamomile, known in Spanish as manzanilla, is one of the most popular herbs used by Mexican Americans and is commonly recommended during pregnancy to ease nausea and heartburn and as a general relaxant.

The leaf and root of marshmallow are rich in mucopolysaccharides that soothe and protect the esophageal lining from irritation. Marshmallow was a food herb for centuries and is considered safe for use during pregnancy. The German health authorities endorse the use of marshmallow root for “mild inflammation of the gastric mucosa.”21 There are no known contraindications to marshmallow; however, because of the high mucilage content, marshmallow may delay the absorption of medications.22 Prescription medications should be taken at least 30 minutes before using this herb.

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Intestinal-Based Diseases and Peripheral Infection Risk Associated with Gut Dysbiosis: Therapeutic use of Pre- and Probiotics and Fecal Microbiota Transplantation

Bryan Tungland, in Gerd knabe Foods To Avoid (☑ Natural Heartburn Remedies) | Gerd knabe Treatmentshow to Gerd knabe for Human Microbiota in Health and Disease, 2018

6.3 Gastric acid-related disorders [heartburn, gastroesophageal reflux (GERD)] and effects of pro- and/or prebiotic treatment

Heartburn, also called acid indigestion, is the most common symptom of gastroesophageal reflux (GERD) and is characterized as a burning chest pain beginning behind the sternum and moving upward to the neck and thorax. Today, more than 60 million American adults experience heartburn at least once a month, and more than 15 million adults suffer daily from heartburn (WebMD, 2016). Many pregnant women experience daily heartburn. Recent studies show that GERD in infants and children is more common than previously recognized and may produce recurrent vomiting, coughing, and other respiratory problems.

Antacids are often used to help neutralize acid in the esophagus and stomach and stop heartburn. Many people find that nonprescription antacids provide temporary or partial relief. An antacid combined with a foaming agent helps some people. These compounds are believed to form a foam barrier on top of the stomach that prevents reflux from occurring. However, long-term use of antacids can result in side effects, including diarrhea, altered calcium metabolism (a change in the way the body breaks down and uses calcium), and hypermagnesemia in the body. Elevated magnesium can be serious for patients with kidney disease. For chronic reflux and heartburn, medications that reduce acid in the stomach may be used. These medicines include acid (H2) blockers, which inhibit acid secretion in the stomach. H2 blockers include: cimetidine (Tagamet), famotidine (Pepcid), nizatidine (Axid), and ranitidine (Zantac). In addition to these treatments, proton pump inhibitors (PPIs) or acid pump inhibitors are used to irreversibly block the hydrogen/potassium adenosine enzyme system (the H+/K+ ATPase, or as it is more commonly known, the gastric proton pump of the gastric parietal cells (Alhazzani et al., 2013). Some of the PPIs include esomeprazole (Nexium), Iansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (Aciphex), dexlansoprazole (Dexilant), and omeprazole/sodium bicarbonate (Zegerid). PPIs are among the most widely sold drugs in the world, and the first one, omeprazole, is on the WHO Model List of Essential Medicines (World Health Organization (WHO), 2013). Their use among the elderly is on the rise (Gomm et al., 2016; Hollingworth et al., 2010). However, the use of PPIs can have significant consequences on health. In a 2016 study, research evaluated 74,000 elderly participants, age 75 and older, with no dementia at the onset of study over a 7-year period (Gomm et al., 2016). The researchers found that participants taking a PPI were 44% more likely to develop dementia than individuals not on a PPI, even after statistical adjustment for age, sex, and the use of multiple medications. In a second, large longitudinal study (German Study on Aging, Cognition, and Dementia) more than 3300 elderly (>75 years) that were followed every 18 months for 6 years, those using PPIs had a 38% increased risk of dementia, and a 44% increase in the risk of Alzheimer's disease, compared with those with no history of PPI use (Haenisch et al., 2015). Recent research has also demonstrated that even short-term PPI use impairs cognition in healthy young volunteers (ages 20–26 years). After only 7 days of exposure to PPIs, all of the drug recipients had a statistically significant impairment of cognitive function, measured against baseline visual memory, attention, executive function, working memory, and planning functions (Akter et al., 2015). In this study, omeprazole (Prilosec®), the most commonly prescribed PPI, reduced cognitive function the greatest, while others including, lansoprazole and pantoprazole, rabeprazole, and esomeprazole, had lower, but significant influences. The mechanism involved in this health issue involves the impairment of acid production in the microglia cells of the brain, which is necessary to break down beta-amyloid plaque to be removed by the microglia cells (Fallahzadeh et al., 2010; Majumdar et al., 2011). PPIs pass the blood–brain barrier and reduce acid levels contained within the lysosomes of the microglia (Fallahzadeh et al., 2010). Studies have shown that acid levels in the lysosomes of the brains of patients with Alzheimer's are significantly lower than those of healthy individuals (Guha et al., 2014; Wolfe the 1 last update 09 Aug 2020 et al., 2013Guha et al., 2014; Wolfe et al., 2013). As pro- and prebiotics have been shown to reduce mechanisms associated with the development of cerebral inflammatory response, and amyloid plaque formation, they may also be useful during PPI use, see Alzheimer's disease sections under periodontal disease and diseases of the CNS. However, finding effective alternatives to PPIs is likely necessary.

Some alternatives to PPIs have shown significant promise in treating heartburn and GERD. By example, a combination of two nutrients, zinc and carnosine, has shown to be highly effective in individuals with stomach ulcers, especially in those cases associated with Helicobacter pylori infection (Kashimura et al., 1999; Suzuki et al., 1999; Matsukura and Tanaka, 2000). More recently, raft-foaming alginate gels have also shown promise in preventing reflux symptoms such as heartburn (Kapadia and Mane, 2007; Quartarone, 2013; Strugala et al., 2009; Sweis et al., 2013; Tytgat and Simoneau, 2006). Hamilton-Miller (2003) in his review reported several studies using the probiotic lactobacilli in vitro inhibit or kill the H. pylori bacteria by preventing its adhesion to epithelial cells for 1 last update 09 Aug 2020 and prevent IL-8 release. In in vivo models, pretreatment with probiotic prevented H. pylori infections or markedly reduced an existing infection. In several human studies, a probiotic was found to clear an infection, or reduce side effects of infection.Some alternatives to PPIs have shown significant promise in treating heartburn and GERD. By example, a combination of two nutrients, zinc and carnosine, has shown to be highly effective in individuals with stomach ulcers, especially in those cases associated with Helicobacter pylori infection (Kashimura et al., 1999; Suzuki et al., 1999; Matsukura and Tanaka, 2000). More recently, raft-foaming alginate gels have also shown promise in preventing reflux symptoms such as heartburn (Kapadia and Mane, 2007; Quartarone, 2013; Strugala et al., 2009; Sweis et al., 2013; Tytgat and Simoneau, 2006). Hamilton-Miller (2003) in his review reported several studies using the probiotic lactobacilli in vitro inhibit or kill the H. pylori bacteria by preventing its adhesion to epithelial cells and prevent IL-8 release. In in vivo models, pretreatment with probiotic prevented H. pylori infections or markedly reduced an existing infection. In several human studies, a probiotic was found to clear an infection, or reduce side effects of infection.

A recent double-blind trial involving 105 patients with IBS fulfilling Rome II criteria with minor intensity of symptoms showed that supplementation with 5 g/d scFOS for 6 weeks was significantly more effective than a placebo at relieving symptoms of dyspepsia such as indigestion, heartburn, low stomach acidity, fullness, constipation urgency, and diarrhea. The average symptom severity decreased by 44% with FOS supplementation (Paineau et al., 2008).

In addition to dementia, PPIs also induce hypomagnesemia, a defect in intestinal absorption of magnesium. Recently, patients with PPI-induced hypomagnesemia that received two 14-day cycles of 20 g of inulin/day significantly enhanced serum magnesium levels from 0.60 to 0.68 mmol/L. As a consequence, 24-h urinary magnesium excretion was significantly increased in patients with PPI-induced hypomagnesemia (0.3–2.2 mmol/d). Symptoms of muscle cramps and paraesthesia associated with hypomagnesemia were reduced during inulin intervention.

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Gerd knabe Quick Relief (👍 Acid Reflux) | Gerd knabe Heartburn Relief Foodshow to Gerd knabe for Gastrointestinal Disorders

Noel Lee, ... Sumona Saha, in Clinical Pharmacology During Pregnancy, 2013

25.1 Gastroesophageal reflux disease

Heartburn is estimated to affect 30 to 50% of pregnant women. In some populations, the incidence may be as high as 80% [1]. Risk factors for heartburn in pregnancy include increasing gestational age, parity, and a history of heartburn [2]. Although the terms “heartburn” and “gastroesophageal reflux disease” (GERD) are often used interchangeably, the two are distinct entities. Heartburn is a symptom, whereas GERD is a disorder associated with symptoms, the most common being heartburn and potential complications [3].

The pathophysiology of GERD is believed to be multi-factorial. Decreased resting lower esophageal sphincter (LES) pressure due to the effects of estrogen and progesterone are thought to be important contributors to gestational GERD along with decreased sensitivity of the LES to physiologic stimuli [4]. Other proposed factors include decreased esophageal peristalsis, esophageal dysmotility and delayed gastric emptying due to hormonal and mechanical changes [5].

While most pregnant women with heartburn experience this for the first time in pregnancy some may suffer from GERD [6]. Most patients have a benign disease course, with only a few experiencing GERD-related complications such as gastrointestinal bleeding or stricture formation. In general, symptoms begin at the end of the first trimester, worsen through the remainder of pregnancy, and then resolve promptly after delivery.

25.1.1 Treatment

Gerd knabe Herbal Remedies (🔴 Heartburn Remedies) | Gerd knabe Causeshow to Gerd knabe for 25.1.1.1 Therapeutic lifestyle modifications

Treatment of GERD in pregnancy should follow a “step-up” approach. Treatment should begin with therapeutic lifestyle modifications including strict abstinence from tobacco and alcohol and avoiding late-night meals, recumbency after eating, and trigger foods (e.g. spicy or sour foods, carbonated beverages, coffee, and chocolate). Eating several small meals throughout the day and elevating the head of the bed by 6 inches may provide additional benefit [7]. In addition, medications known to provoke GERD such as anticholinergics, sedatives, theophylline, prostaglandins, and calcium channel blockers should be discontinued, when possible. It is estimated that 25% of patients with uncomplicated GERD resolve their symptoms by making these modifications for 1 last update 09 Aug 2020 [8][8].

25.1.2 Antacids

For patients who fail to respond to conservative measures antacids and alginic acid constitute first-line pharmacologic therapy. Aluminum, magnesium, and calcium-based antacids have no Food and Drug Administration (FDA) classification and are generally considered safe in pregnancy. Calcium-based antacids have the added benefit of increasing calcium intake which has been associated with the prevention of preeclampsia [9].

Patients taking antacids, however, should be aware of the possibility of aluminum-containing antacids causing constipation,Gerd knabe 7 Natural (🔴 Naturally Treat) | Gerd knabe What Causes Heartburnhow to Gerd knabe for and magnesium-containing antacids causing diarrhea [10]. Magnesium-containing antacids should be avoided later in pregnancy, due to their ability to arrest labor and precipitate seizures. Also patients on iron should be advised not to take iron and antacids together in order to maximize iron absorption by an acidic gastric pH. Sodium bicarbonate should not be taken due to the risk of metabolic alkalosis and fluid overload in the mother and fetus [11].

Alginic acid is considered effective and fast acting in most pregnant patients. Although it has not been studied extensively it should be safe because it is not absorbed systemically. An open-label trial reported “very good” or “good” symptom relief in the majority of women taking alginic acid within 10 minutes [12].

25.1.3 Sucralfate

Gerd knabe Home Remedy Solutions (☑ How To Get Rid) | Gerd knabe How To Get Rid Ofhow to Gerd knabe for Sucralfate (FDA category B) is an aluminum salt of a sulfated disaccharide. As it is poorly absorbed from the GI tract, it acts mainly as a local mucosal protectant. Sucralfate has been shown in a randomized controlled trial in pregnancy to provide greater relief from for 1 last update 09 Aug 2020 heartburnheartburn and regurgitation than lifestyle and dietary modifications alone the 1 last update 09 Aug 2020 [13][13].

25.1.4 Promotility agents

Gerd knabe Disease Treatment (👍 Natural Heartburn Remedies) | Gerd knabe Acid Refluxhow to Gerd knabe for Metoclopramide (FDA category B) is a prokinetic, dopamine agonist which may be useful in the treatment of GERD by increasing LES pressure, improving esophageal acid clearance, and promoting gastric emptying. Use of metoclopramide is often limited by its poor tolerability and the risk for extra-pyramidal side effects. It has been associated in rare cases with tardive dyskinesia, causing the FDA to issue a black-box warning concerning the use of this drug in 2009. The risk of the development of this complication increases with high dose or long-term use of the drug and continues even after the drug has been discontinued.

25.1.5 H2-Receptor antagonists

The H2-receptor antagonists (H2-RAs) form the next tier of therapy. The four H2-RAs (ranitidine, cimetidine, famotidine, and nizatidine; FDA category B) are considered safe in pregnancy. A recent meta-analysis by Gill et al. with data from 2398 H2-RA-exposed pregnancies and 119,892 unexposed controls found no increased risk of fetal malformations with the use of H2-RAs in pregnancy [14]. No increased risks for spontaneous abortions, preterm delivery, and small for gestational age were found either. for 1 last update 09 Aug 2020

Gerd knabe What To Eat (🔥 Common Heartburn Triggers) | Gerd knabe 7 Natural GERDhow to Gerd knabe for Despite the longstanding availability of H2-RAs, only ranitidine, studied at a dose of 150 mg twice daily, has been shown in a randomized, double-blind trial to be efficacious in pregnancy, making it the preferred H2-RA for gestational GERD [15]. Cimetidine is likely equally effective; however, due to the anti-androgenic effects seen in animals and non-pregnant humans, some authors advise against its use in pregnancy [16,17]. Although it appears to be safe, famotidine carries fewer safety data in pregnancy and is considered a second-line H2-RA in pregnancy. Nizatidine recently changed FDA pregnancy classification from C to B. Although it is approved for use in pregnancy, as studies in some animal models have reported abortions, fewer live fetuses, and low fetal weights with high dose exposure [18], it is a less preferred option among the H2-RAs [6].

Gerd knabe Heartburn (☑ 11 Foods That Cause) | Gerd knabe What Causes Heartburnhow to Gerd knabe for 25.1.6 Proton pump inhibitors

Proton pump inhibitors (PPIs) are typically reserved for patients with severe symptoms refractory to lifestyle modification and the older generation medications. Four of the five PPIs (lansoprazole, rabeprazole, pantoprazole, and esomeprazole) are FDA category B. Omeprazole, however, is FDA category C rating due to fetal toxicity in animal studies.

Despite their favorable pregnancy classification, concern over the long-term safety of PPIs has limited their use. However, there is now a large amount of data supporting their safety in pregnancy. A 2009 meta-analysis by Gill et al. which included 1530 PPI-exposed and 133,410 non-exposed controls found no increased risk for major malformations, spontaneous abortions or preterm delivery with first-trimester use of PPIs for 1 last update 09 Aug 2020 [19][19].

A Danish cohort study examining 840,968 live births, of which 5082 were exposed to a PPI between 4 weeks before conception and the end of the first trimester, did find a minor difference in abnormalities in the newborns of exposed (3.2%) and non-exposed (2.6%) women (adjusted prevalence odds ratio, 1.23; 95% CI, 1.05 to 1.44) [20]. The risk of birth defects, however, was not significantly increased in secondary analyses of exposure to individual PPIs during the first trimester.

Thus, based on the available data, PPI use in pregnancy does appear to be safe. First trimester exposure, however, should be avoided when possible due to the possible increased risk for fetal malformations. While most patients can be effectively treated with once-a-day dosing some may need to be dosed twice daily.

The various medical therapies for GERD are summarized in Table for 1 last update 09 Aug 2020 25.1Table 25.1.

Table 25.1. Medications for gastroesophageal reflux disease

DrugFDA pregnancy categoryRecommendations in pregnancyRecommendations in lactation
AntacidsCalcium-basedNASafeCompatible
Magnesium-basedAvoid in late pregnancy as may arrest labor and precipitate seizures; can cause diarrhea
Aluminum-basedCan cause constipation and possibly fetal neurotoxicity
Alginic acidSafe
Sodium bicarbonateContraindicated due to risk for maternal fluid overload
and metabolic alkalosis
SucralfateBSafeCompatible
MetoclopramideBAvoid long-term, high dose use due to risk for tardive dyskinesiaLimited human data: potential toxicity
H2-receptor antagonistsRanitidineBPreferred H2-RA in pregnancyAll safe except nizatidne
CimetidineMay have anti-androgenic properties
FamotidineProbably safe
NizatidineProbably safe but less preferred H2-RA
Proton pump inhibitorsOmeprazoleAll B except omeprazole (C)Reserve for refractory patients; avoid first trimester useNot recommended
Lansoprazole
Pantoprazole
Rabeprazole
Esomeprazole

NA – Not applicable.

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PREGNANCY | Safe Diet

R.B. Fraser, F.A. Ford, in Encyclopedia of Food Sciences and Nutrition (Second Edition), 2003

Nutritional Management of Common Symptoms in Pregnancy

Heartburn

Heartburn is thought to be caused by gastroesophageal reflux. Although occasionally experienced in the first trimester, it is generally more common in the for 1 last update 09 Aug 2020 last trimester and occurs in 30–50% of women.Heartburn is thought to be caused by gastroesophageal reflux. Although occasionally experienced in the first trimester, it is generally more common in the last trimester and occurs in 30–50% of women.

Small, frequent meals or snacks are usually tolerated better than large, well-spaced meals. Common foods cited as causing heartburn as spicy and fatty foods, fizzy drinks, citrus fruits, fruit juices, and cucumber. Milk and milk products can help to relieve symptoms but antacids are frequently used.

Nausea and Vomiting

Psychological factors, changing hormone levels, hunger, altered carbohydrate metabolism, and vitamin deficiencies have all been proposed as possible causes for nausea and vomiting, but none has the 1 last update 09 Aug 2020 been confirmed.Psychological factors, changing hormone levels, hunger, altered carbohydrate metabolism, and vitamin deficiencies have all been proposed as possible causes for nausea and vomiting, but none has been confirmed.

Symptoms may start before the woman knows she is pregnant or in later pregnancy but commonly they are worst between weeks 6 and 10, and subside by about 13 weeks. Nausea is experienced at any time of day or night and can be either slight or severe. It often becomes worse when the stomach is empty, and eating small, frequent meals based on starchy carbohydrates may relieve it. Morning sickness is common and consuming dry biscuits or toast before getting up can relieve this.

Nausea can also be triggered by traveling, fried and spicy foods, and smells such as coffee, perfume, and cigarette smoke.

the 1 last update 09 Aug 2020 Some women just feel nauseated while others actually vomit as well; this may cause minor weight loss but rarely causes nutrient deficiency. Women need reassurance that not eating proper cooked meals or losing some weight and their taste alterations will cause no problems for their developing fetus. The more severe cases of pregnancy vomiting (hyperemesis gravidarum) require hospital admission, intravenous fluids and, sometimes, parenteral nutrition.

Constipation

Constipation is common at all stages of pregnancy. It may be related to a general reduction in motility in the gastrointestinal tract, with prolonged transit times and increased water resorption from the stool. General advice about constipation is also suitable for pregnancy, i.e., increased intake of fiber, particularly cereal fiber, and increased fluid intake.

Constipation may be aggravated by the consumption of iron tablets; if it is not appropriate to reduce or stop them, bulking agents may be prescribed.

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