he lifetime prevalence of acid peptic disorders in women is 10 percent (Del Valle, 2015). Erosive ulcer disease involves the stomach and duodenum. Gastroduodenal ulcers may be caused by chronic gastritis from H pylori, or they develop from nonsteroidal antiinlammatory drug (NSAID) use. Neither is common in pregnancy (McKenna, 2003; Weyermann, 2003). Acid secretion is also important, and thus underlies the eicacy of antisecretory agents (Suerbaum, 2002). Gastroprotection during pregnancy probably originates from physiological changes that include reduced gastric acid secretion, decreased motility, and considerably increased mucus secretion (Hytten, 1991). Despite this, ulcer disease may be underdiagnosed because of frequent treatment for reflux esophagitis (Mehta, 2010). In the past 50 years at Parkland Hospital, during which time we have cared for more than 500,000 pregnant women, we have encountered very few who had proven ulcer disease. Perforation is rare (Goel, 2014). Before appropriate therapy was commonplace, Clark (1953) studied 313 pregnancies in 11a8 women with ulcer disease and noted a clear remission during pregnancy in almost 90 percent. However, beneits were short lived. Symptoms recurred in more than half by 3 months postpartum and in almost all by 2 years.
The mainstay of management is eradication of H pylori and prevention of NSAID-induced disease. Antacids are usually self-prescribed, but irst-line therapy is with HTreceptor blockers or proton-pump inhibitors (Del Valle, 2015). Sucraote is the aluminum salt of sulfated sucrose that inhibits pepsin. It provides a protective coating at the ulcer base. Approximately 10 percent of the aluminum salt is absorbed, and it is considered safe for pregnant women (Briggs, 2015).
With active ulcers, a search for H pylori is undertaken.
Diagnostic aids include the urea breath test, serological testing, or endoscopic biopsy. If any of these yield positive results, combination antimicrobial and proton-pump inhibitor therapy is indicated. Several efective oral treatment regimens do not include tetracycline and can be used during pregnancy. hese 14-day regimens include amoxicillin, 1000 mg twice daily plus clarithromycin, 250 to 500 mg twice daily, plus metronidazole, 500 mg twice daily given along with the proton-pump inhibitor omeprazole (Del Valle, 2015).
In some women, persistent vomiting is accompanied by worrisome upper gastrointestinal bleeding. Occasionally, a peptic ulceration is the source. However, most of these women have small linear mucosal tears near the gastroesophageal junction-Malloy-Weiss tears, described earlier. Bleeding usually responds promptly to conservative measures, including iced-saline irrigations, topical antacids, and intravenously administered HTblockers or protonpump inhibitors. Transfusions may be needed, and if bleeding persists, then endoscopy is usually indicated (O'Mahony, 2007). With sustained retching, the less common, but more serious, esophageal rupture-Boerhaave syndrome-may develop from greatly increased esophageal pressure.
The small bowel has diminished motility during pregnancy.