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Dyspepsia - pregnancy-associated - Management
How should I assess a pregnant woman who has dyspepsia?
- Take a detailed history. Ask about:
- Symptoms and how they are affecting the woman's quality of life: heartburn and acid reflux are common, but people may also describe upper abdominal discomfort, retrosternal pain, anorexia, bloating, fullness, or early satiety.
- Previous history of gastro-oesophageal reflux disease or peptic ulcer disease.
- Features suggesting a serious cause (alarm features) or an illness unrelated to pregnancy (e.g. symptoms of fever, rigours, vomiting, and malaise).
- Lifestyle (e.g. diet and medication) that may worsen dyspepsia.
- Treatments already tried, especially over-the-counter medication (antacids).
- Examination is usually normal, and investigations are generally not necessary.
Clarification / Additional information
- Signs: epigastric tenderness may be present, but is a poor discriminating sign [NICE, 2005].
- Investigations: are usually carried out in secondary care and may include:
- An endoscopy.
- Testing for Helicobacter pylori, which may be delayed until after delivery, since eradication therapy is contraindicated during pregnancy [Mahadevan and Kane, 2006].
Basis for recommendation
These recommendations are largely based on expert opinion [Ali and Egan, 2007], and pragmatic advice:
- Knowing the individual's diet and lifestyle, the symptom severity, and previously tried treatments will allow the healthcare professional to judge the next step in dyspepsia management.
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