Stomach and Duodenal Ulcers and Erosive Esophagitis
INFORMATION FOR WOMEN WHO HAVE STOMACH OR DUODENAL ULCERS, AND/OR EROSIVE ESOPHAGITIS DURING PREGNANCY OR BREASTFEEDING
What are stomach or duodenal ulcers and erosive esophagitis?
A peptic ulcer is a sore in the inner lining of the stomach or intestine. Also known as a gastric ulcer, a stomach ulcer is a painful open sore in the lining of the stomach, whereas a duodenal ulcer is found in the lining of the duodenum, the first section of the small intestine that connects with the stomach. Erosive esophagitis is a severe complication of acidic stomach contents flowing the wrong way up into the esophagus (gastroesophageal reflux disease [GERD]) and eroding (wearing out) the parts of the esophageal wall. Also called ulcerative esophagitis, erosive esophagitis is most likely from severe GERD, but also can occur together with peptic ulcer disease. Most commonly, gastric and duodenal ulcers are caused by infection with Helicobacter pylori, a corkscrew-shaped bacterial species that can infect the upper portions of the human gastrointestinal (GI) tract. H. pylori infection, leading to peptic ulcer disease, can develop during pregnancy, just as it can develop outside of pregnancy. Erosive esophagitis can occur during pregnancy, because the growing womb puts pressure on abdominal contents, making you more susceptible to GERD.
How common are stomach or duodenal ulcers and erosive esophagitis during pregnancy?
Gastric and duodenal ulcers are common during pregnancy because H. pylori infects an estimated 50 percent of the human population. The chances of infection are influenced strongly by geography, ethnicity and socioeconomic status. The highest rates of infection are found in developing countries, most infections begin in childhood, and the risk is highest in places with poor hygiene practices. H. pylori infects about 20-30 percent of pregnant women in European countries, Australia, and Japan, while very high rates of infection, up to 80 percent, have been reported in Egypt and Gambia. Turkey has reported rates ranging from 50-70 percent. Symptoms do not develop in everybody who is infected, but pregnancy increases your chance of becoming infected. Erosive esophagitis is rare, but GERD is quite common during pregnancy, so erosive esophagitis does occur among pregnant women.
How are stomach or duodenal ulcers and erosive esophagitis diagnosed?
Determination of whether you have stomach or intestinal disease is made based on your history, particularly symptoms of upper abdominal pain, nausea, and bloating. You doctor will examine you to look for specific problems such as GERD and ulcers, and ask questions such as whether the symptoms are worse after you eat or before you eat. GERD tends to be worse after a meal, but peptic ulcers can feel worse between meals. To test your stomach for the presence of Helicobacter pylori, which causes gastric and duodenal ulcers, your doctor may order whats called a urea breath test in which youll be given a light meal with an agent called urea that is labeled with a special carbon atom that can be detected either by a radiation sensor (carbon-14), or through a process called mass spectrometry (carbon-13). To evaluate you for GERD, and to test for damage to the esophagus such as erosive esophagitis, you may be sent for a procedure called upper endoscopy in which a device with a camera and the ability to take a biopsy is inserted down your throat. If you have GERD or GERD related complications, various imaging tests may be performed to determine whether you have a condition called a diaphragmatic hernia, characterized by part or all of the stomach penetrating into the chest cavity, leading to GERD.
Do stomach or duodenal ulcers and erosive esophagitis cause problems during pregnancy?
Most ulcers in the stomach and duodenum are the result of H. pylori infection. In addition to being painful, such ulcers can lead to perforations in the wall of the GI tract and bleeding, and in the long-term can lead to cancer. An ulcer can lead to bleeding as a complication, which can cause you to become anemic while your blood pressure drops. Additionally, there may be an association between H. pylori and a rare pregnancy complication called hyperemesis gravidarum (HG), which is extreme nausea and vomiting, much worse than usual nausea and vomiting of pregnancy.
GERD can develop, producing heartburn, sore throat, and cough, and if it continues can lead to erosive esophagitis and other severe esophageal complications, all of which can lead eventually to cancer. If you do develop erosive esophagitis, you may develop nausea and vomiting more than what is usual for pregnancy and which continues into the later parts of pregnancy rather than being limited to early pregnancy. Erosive esophagitis can make it difficult to swallow and can suppress your appetite, leading to malnutrition. You may also develop sores in your mouth due to exposure of the mouth to stomach acid as well.
Do stomach or duodenal ulcers and erosive esophagitis during pregnancy cause problems for the baby?
Its possible that H. pylori infection could increase the risk of slow growth in the womb, congenital malformations, and even death of the baby, although more studies are needed to determine if such a risk is real. Gastric and duodenal ulcers do not affect the baby directly, but if you develop a bleeding ulcer, causing a blood loss, it can disrupt the delivery of oxygen and nutrients to the placenta and the developing baby, leading to insufficient growth, or loss through spontaneous abortion (miscarriage). Erosive esophagitis can lead to an inability to swallow and lack of appetite that can lead, in turn, to nutritional deficiencies, disrupting growth in the womb and contributing further to the risk of spontaneous abortion.
What to consider about taking medications when you are pregnant:
- The risks to yourself and your baby if you do not treat the stomach or duodenal ulcers and erosive esophagitis
- The risks and benefits of each medication you use when you are pregnant
- The risks and benefits of each medication you use when you are breastfeeding
What should I know about using medication to treat stomach or duodenal ulcers and erosive esophagitis during pregnancy?
H. pylori infection that underlies most stomach and duodenal ulcers is treated with triple therapy, meaning a combination of three or sometimes four medications, in which case it is called quadruple therapy. These medications include a proton pump inhibitor, such as lansoprazole or omeprazole, which reduces acid production in the stomach. They also include one or two antibiotics, such as clarithromycin or metronidazole, and a bismuth-containing drug, such as bismuth biskalcitrate. There has been some suspicion that clarithromycin could increase the risk of spontaneous abortion (miscarriage) early in pregnancy, but generally, the drug is considered relatively safe, as is metronidazole. Most pr
oton pump inhibitors are considered pregnancy safe, as are certain bismuth drugs.
GERD and erosive esophagitis can be treated with medications called H2 blockers, agents that reduce acid production, including cimetidine, famotidine, nizatidine, and ranitidine, and/or with proton pump inhibitors.
Who should NOT stop taking medication for stomach or duodenal ulcers and erosive esophagitis in pregnancy?
If you have an H. pylori infection causing an ulcer you should complete the full course of your medication treatment in order to get rid of the infection. You also should continue H2 blocker and proton pump inhibitor medication. Discuss any problems that develop after you begin drug treatment with your physician. If the problem turns out to be a side effect or complication of the drug, your doctor may be able to replace it with different medicine.
What should I know about choosing a medication for stomach or duodenal ulcers and erosive esophagitis in pregnancy?
You may find Pregistrys expert reports about the individual medications to treat stomach and duodenal ulcers and erosive esophagitis here. Additional information can also be found in the sources listed at the end of this report.
What should I know about taking a medication for stomach or duodenal ulcers and erosive esophagitis when I am breastfeeding?
Proton pump inhibitors, most bismuth drugs, clarithromycin, metronidazole, and most of the other antibiotics that often are used against H. pylori, are thought to be safe during breastfeeding.
What alternative therapies exist besides medications to treat stomach or duodenal ulcers and erosive esophagitis during pregnancy?
In order for the lining of the stomach, duodenum, and esophagus to heal, medications are needed to counter the release of stomach acid, which does damage in the case of all of the conditions discussed in this report. In conditions resulting from H. pylori, medication is required in order to eradicate the infection and in all cases. In some instances of bleeding ulcers and erosive esophagitis, there are surgical procedures that may be offered, or that may be required in an emergency to stop bleeding from an ulcer, or to make it easier to swallow food. In most cases, such procedures can be performed through an endoscope, rather than through an open approach in which the abdomen or chest is cut.
What can I do for myself and my baby when I have stomach or duodenal ulcers and erosive esophagitis during pregnancy?
Work with, and follow the recommendations of, your obstetrician, gastroenterologist, and other specialists that take care of you. Complete the entire course of your medication regimen as directed and get plenty of rest.
Resources for stomach or duodenal ulcers and erosive esophagitis during pregnancy:
For more information about stomach or duodenal ulcers and erosive esophagitis during pregnancy, contact http://www.womenshealth.gov/ (800-994-9662 [TDD: 888-220-5446]) or read the following articles: