Heartburn and Pregnancy (1)
ACID REFLUX DURING PREGNANCY: WHAT IS IT? MAZÉ?

Dr. Claude Allouche, Gynecologist
Ahuza Clinic, Raanana
058 726 02 64

Acid reflux, heartburn, regurgitation, gastroesophageal reflux (GERD), pyrosis, in Hebrew tsarevet, צרבת...:
So many different terms for these digestive disorders that affect nearly half of expectant mothers in late pregnancy.
Although benign, they can cause significant discomfort on a daily basis.

But what is it exactly?

We refer to acid reflux when part of the stomach contents flows back into the esophagus and sometimes even into the mouth, leaving a bitter and unpleasant taste.
This gastric acid, being acidic, can irritate the walls of the esophagus and cause a burning sensation (pyrosis) from the throat to the bottom of the sternum.
These acid reflux episodes are sometimes accompanied by bloating, belching, and epigastric pain.
These digestive disorders are common in the third trimester, but they can occur earlier during pregnancy.
As the uterus increasingly compresses the stomach, the symptoms tend to worsen over the months, reaching their peak in the weeks leading up to delivery.
They generally subside spontaneously after childbirth.

ACID FLOW DURING PREGNANCY: WHY?

Acid reflux or heartburn, tsarevet in Hebrew (צרבת), occurs frequently during pregnancy, why?

Different factors favor acid reflux during pregnancy:

1/ the hormonal climate:

- With their relaxing action on the tissues, progesterone and relaxin cause relaxation of the cardia, this small muscle that closes the top of the stomach. Less toned, the cardia no longer plays its role as an "anti-reflux valve" and then allows the acidic gastric contents to rise into the esophagus.

- These same hormones also cause the muscles of the stomach to relax, resulting in a decrease in the contractile movements of the stomach. Digestion therefore becomes slower, gastric emptying is less effective.

2/ the pressure of the uterus and the baby on the stomach at the end of pregnancy

These different factors cause the contents of the stomach to tend to rise up into the esophagus.

3/ Food: certain foods can promote acid reflux:

- spicy or fatty dishes;
- coffee, tea;
- sodas and soft drinks;
- the sweets ;
- foods that ferment (cabbage, onion, garlic, pulses, etc.).

4/ Stress

5/ Fatigue

6/ The lying position

All of these factors can make symptoms worse.

ACID BACKWARDS DURING PREGNANCY: HOW TO AVOID THEM?

Acid reflux or heartburn, tsarevet in Hebrew (צרבת), is common during pregnancy, but what can be done to avoid it?

Hygieno-dietetic rules and diet can prevent and avoid acid reflux during pregnancy

But every mom-to-be should try to identify the foods that cause heartburn in her.

1/ Foods that promote heartburn

In general, certain foods are known to promote heartburn:

- spicy or fatty dishes;
- coffee, tea;
- sodas and soft drinks;
- the sweets ;
- foods that ferment (cabbage, onion, garlic, pulses, etc.).

By limiting the consumption of these foods, this can help prevent the occurrence of acid reflux.

2/ Foods that limit heartburn

Other foods, on the other hand, would limit acid reflux:

- All alkaline foods, including most fruits and vegetables
- the potato, alkaline, is reputed to be effective in buffering gastric acidity, in all its classic forms except fries, which should be avoided because they are too fatty.
- certain fruits contain a large amount of digestive enzymes that promote digestion, and therefore gastric emptying: pineapple, papaya for example.

3/ Hygyeno-dietary measures

On a daily basis, various small gestures help, through a mechanical effect, to limit acid reflux:

- Split meals into 3 small meals and 2 or 3 snacks

- Avoid overeating

- After the meals:
    * Avoid lying down, if possible within 3 hours after the meal
    * Avoid overexertion
    * Avoid leaning forward;

- Raise the head of your bed a few tens of centimeters or sleep with a few cushions behind your back;

- Wear loose and comfortable clothes to avoid compressing the stomach;

- Practice regular physical activity such as walking to stimulate digestion;

- Use relaxation techniques (breathing, meditation, sophrology, yoga, etc.) to reduce stress, an aggravating factor for acid reflux.

ACID BACKFLOW DURING PREGNANCY: WHAT TREATMENT?

- Acid reflux or heartburn, tsarevet in Hebrew (צרבת), occurs frequently during pregnancy, but how to treat it when it is already there?

- Apart from the hygiene and dietary measures mentioned above, what are the possible treatments?

- Gastroesophageal reflux being a symptom that is certainly annoying, but which remains benign, it is possible to start by using what are called alternative medicines, before passing the medicine itself if they remain ineffective

- Homeopathy and phytotherapy are interesting resources against acid reflux in pregnant women and generally safe during pregnancy.
The best is to consult your homeopath or naturotherapist who will be able to choose the substances adapted to the nature of your symptoms.

- As part of phytotherapy, herbal teas of lemon balm or Roman chamomile help reduce gastric acidity and facilitate digestion.
- The decoction of marshmallow root or flax seeds will act as a mucilage: in contact with water they form a gel that lines the wall of the esophagus.

- Osteopathy can contribute to limiting acid reflux by helping, with manual manipulations, the body to better adapt to the changes induced by pregnancy, but it must be reserved for trained hands...

- Acupuncture would also treat the terrain by restoring the circulation of chi, the vital energy.
It could thus contribute to limiting the various ailments of pregnancy, including acid reflux. Again, it is better to turn to an experienced acupuncturist for this type of symptom during pregnancy.
 
- Baking soda (food) is a "grandmother's remedy and would help neutralize stomach acid.
Mix ½ teaspoon with a few drops of lemon juice (which contrary to its acid flavor is not acidifying but alkaline) in 100 ml of warm water and drink this decoction during the day.

- If lifestyle and dietary measures and alternative medicine are insufficient, it is possible to resort to allopathy, taking care, however, to avoid self-medication – basic rule throughout pregnancy – because certain specialties are contraindicated during pregnancy .

- Antacids such as Gaviscon, Maalox, Rennie can be offered to women whose gastroesophageal reflux persists despite lifestyle and dietary measures.
- Gastric antisecretory drugs (H2 antihistamines) are effective; their use is reserved for cases where antacids are ineffective.
- Proton pump inhibitors such as omeprazole should only be used as a last resort.