Pregnancy Heartburn in Nigerians and Caucasians With Theories About Aetiology Based on Manometric Recordings From the Oesophagus and Stomach

Abstract

SummaryA study by questionnaire of the incidence of pregnancy heartburn in two groups of Nigerians and one group of Caucasians showed an incidence of 9·8 per cent in all Nigerians as against 78·8 per cent in Caucasians. The difference was highly significant (x2= 102·75; P<0·0001). An oesophageal manometric study of the lower oesophageal sphincter in 12 non‐pregnant women and in 12 pregnant Nigerians (10 without heartburn and 2 with heartburn) showed that the mean lower oesophageal sphincter pressure (±SD) in the pregnant patients without heartburn was 20·1 ±7·0 mm Hg as against 17·9 ±7·0 in the non‐pregnant women. While one pregnant subject without heartburn had a lower oesophageal sphincter which was partially displaced into the thorax, none of the non‐pregnant women had such sphincter displacement. The two pregnant women with heartburn had low resting sphincter pressures and in both of them the sphincters were partially in the thorax. It is argued that pregnancy heartburn is due to the displacement of the lower oesophageal sphincter into the negative pressure environment of the thorax where the sphincter is less capable of resisting reflux. It is also argued that pregnancy heartburn is commoner in Caucasians than in Nigerians because the sphincter in non‐pregnant Caucasians is often partly intrathoracic and is thus more easily displaced completely into the thorax by the pregnant uterus.

Prevalence and risk factors for gastroesophageal reflux in pregnancy

“…Its prevalence is as high as 80% in some populations [1]. It often manifests during pregnancy and disappears following the delivery [2].…”

Prevalence of gastrointestinal symptoms and related drug use among pregnant women of South-Western Nigeria

“…15 The slightly reduced prevalence in our study compared to that of those in the western world is in agreement with a previous study which showed that pregnancy induced heartburn is commoner in Caucasians than in Nigerians. 25 Constipation has been reported to be the most common of lower gastrointestinal disorders in pregnancy with prevalence between 11-38%. 1,8,26 The 20.7% prevalence of pregnant women with constipation obtained in this study is in agreement, although we did not investigate any other lower GI symptoms for comparison.…”

Management of gastrointestinal and liver diseases during pregnancy

“…Magnesium trisilicate should not be used in high doses for long periods of time due to the risk of fetal nephrolithiasis, hypotonia and respiratory distress 8 9. Sucralfate is not absorbed and appears to be safe, although human data on administration of sucralfate during pregnancy are scarce 24. Alginates are another first-line treatment option,31 with commercially available alginate preparations also containing an antacid.…”

“…Animal studies have revealed increases in both embryonic and fetal mortality with therapeutic doses of omeprazole, although the risk is low, with teratogenic effects seen with excessive doses 24 33 34. However, the safety of omeprazole in humans has been shown in several analyses of prospective data, even with treatment initiation in the first trimester 35–38.…”