Extraesophageal symptoms of gastroesophageal reflux disease during pregnancy

Abstract

Aim: Typical symptoms of gastroesophageal reflux disease (GERD) are known to be frequent in pregnancy. The aim of this study was to gain a first estimation of the occurrence of extraesophageal symptoms in this context.

Methods: A prospective longitudinal study was performed on 166 pregnant women and in a control group of 285 women. The diagnosis of GERD was based on the Montreal classification using the reflux disease questionnaire (RDQ). Extraesophageal symptoms were recorded with a self-administered questionnaire. Typical GERD symptoms and extraesophageal GERD symptoms were recorded in each trimester of pregnancy.

Results: The prevalence of GERD during pregnancy was 16.9 % in the first, 25.3 % in the second and 51.2 % in the third trimester. The prevalence of GERD in the control group was 6.3 %. Asthma was reported by 3.5 % of controls and by 6 % of pregnant women during pregnancy. Chest pain occurred in 6 % of the controls and in 1.8 %, 2.4 % and 2.4 % during the trimesters of pregnancy, chronic cough was reported by 1.1 % of controls and 1.2 % of pregnant women. With the diagnosis of GERD the odds ratios and 95 % confidence intervals for asthma, chronic cough and chest pain in the third trimester of pregnancy were as follows: 1.56 (0.58 – 4.22) for asthma, 0.91 (0.08 – 10.28) for chronic cough and 2.04 (0.49 – 8.46) for chest pain.

Conclusion: GERD is very frequent during pregnancy with progressive incidence during the course of pregnancy. Extraesophageal symptoms of GERD have an unexpected low prevalence during pregnancy.

Zusammenfassung

Einleitung: Symptome der gastroösophagealen Refluxkrankheit (GERD) belasten sehr viele Frauen in der Schwangerschaft. Über die Häufigkeit von atypischen Symptomen in dieser Patientenpopulation ist jedoch nichts bekannt und wir wollten mit der vorliegenden Studie eine erste Einschätzung dieser erreichen.

Methoden: In einer prospektiven Longitudinalstudie wurden 166 schwangere Frauen und eine Kontrollgruppe von 285 Frauen eingeschlossen. Die Diagnose einer GERD wurde basierend auf den Ergebnissen des „Reflux disease questionnaire“ Fragebogens gemäß der Montreal-Definition gestellt. Extraösophageale Symptome wurden anhand eines selbst erstellten Fragebogens erhoben. Typische und atypische Symptome der GERD wurden in jedem Schwangerschaftstrimester erfragt.

Ergebnisse: Die Prävalenz einer GERD in der Schwangerschaft lag bei 16,9 % im ersten, 25,3 % im zweiten und 51,2 % im dritten Schwangerschaftstrimester. Bei den nicht schwangeren Frauen lag die Prävalenz bei 6,3 %. Asthma Symptome wurden von der Kontrollgruppe in 3,5 % und von den Schwangeren in 6 % angegeben. Thoraxschmerzen traten bei der Kontrollgruppe in 6 % auf, bei den Schwangeren in 1,8 %, 2,4 % und 2.4 % in den Trimestern der Schwangerschaft. Chronischer Husten wurde von 1,1 % der Kontrollen und 1,2 % der schwangeren berichtet. Wenn die Diagnose einer GERD bei Schwangeren im dritten Trimester gestellt war lag das relative Risiko und der 95 % Konfidenz Interval für Asthma, chronischen Husten und Thoraxschmerzen wie folgt: 1,56 (0,58 – 4,22) für Asthma, 0,91 (0,08 – 10,28) für chronischen Husten und 2,04 (0,49 – 8,46) für Thoraxschmerzen.

Schlussfolgerung: Die Prävalenz der GERD in der Schwangerschaft ist sehr hoch und steigt im Verlauf der Schwangerschaft. Extraösophageale Symptome treten jedoch überraschend selten auf.

Schlüsselwörter

Refluxösophagitis - GERD - Ösophagus - Schwangerschaft - Asthma - chronischer Husten

Key words

gastroesophageal reflux - GERD - esophagus - pregnancy - asthma - chronic cough

• References

• 1 Malfertheiner P, Hallerback B. Clinical manifestations and complications of gastroesophageal reflux disease (GERD). Int J Clin Pract 2005; 59: 346-355
• 2 Vakil N, van Zanten SV, Kahrilas P et al. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol 2006; 101: 1900-1920; quiz: 1943
• 3 Kahrilas PJ, Hughes N, Howden CW. Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease. Gut 2011; 60: 1473-1478
• 4 Jaspersen D. Extraesophageal manifestations in gastroesophageal reflux disease. Minerva gastroenterol dietol 2006; 52: 269-274
• 5 Wong BC, Kinoshita Y. Systematic review on epidemiology of gastroesophageal reflux disease in Asia. Clinical gastroenterology and hepatology: the official clinical practice. J Am Gastroenterol Ass 2006; 4: 398-407
• 6 Stanghellini V. ReQuest – the challenge of quantifying both esophageal and extra-esophageal manifestations of GERD. Best practice & research Clinical gastroenterology 2004; 18: 27-30
• 7 Chiocca JC, Olmos JA, Salis GB et al. Prevalence, clinical spectrum and atypical symptoms of gastro-oesophageal reflux in Argentina: a nationwide population-based study. Aliment Pharmacol Ther 2005; 22: 331-342
• 8 Fill MalfertheinerS, Malfertheiner MV, Monkemuller K et al. Gastroesophageal reflux disease and management in advanced pregnancy: a prospective survey. Digestion 2009; 79: 115-120
• 9 Rey E, Rodriguez-Artalejo F, Herraiz MA et al. Atypical symptoms of gastro-esophageal reflux during pregnancy. Rev Esp Enferm Dig 2011; 103: 129-132
• 10 Fill MalfertheinerS, Malfertheiner MV, Kropf S et al. A prospective longitudinal cohort study: evolution of GERD symptoms during the course of pregnancy. BMC Gastroenterol 2012; 12: 131
• 11 Nocon M, Kulig M, Leodolter A et al. Validation of the Reflux Disease Questionnaire for a German population. Eur J Gastroenterol Hepatol 2005; 17: 229-233
• 12 Malfertheiner MV, Kandulski A, Malfertheiner P et al. Bronchopulmonary manifestations of gastroesophageal reflux disease. Internist (Berl) 2010; 51 (Suppl. 01) 246-254
• 13 Majithia R, Johnson DA. Are proton pump inhibitors safe during pregnancy and lactation? Evidence to date. Drugs 2012; 72: 171-179
• 14 Pasternak B, Hviid A. Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. New Engl J Med 2010; 363: 2114-2123
• 15 Fill S, Malfertheiner M, Costa SD et al. Handling of the gastroesophageal reflux disease (GERD) during pregnancy – a review. Z Geburtsh Neonatol 2007; 211: 215-223
• 16 Nordenstedt H, Nilsson M, Johansson S et al. The relation between gastroesophageal reflux and respiratory symptoms in a population-based study: the Nord-Trondelag health survey. Chest 2006; 129: 1051-1056
• 17 Vaezi MF. Atypical manifestations of gastroesophageal reflux disease. MedGenMed 2005; 7: 25
• 18 Ruigomez A, Garcia RodriguezLA, Wallander MA et al. Natural history of gastro-oesophageal reflux disease diagnosed in general practice. Aliment Pharmacol Ther 2004; 20: 751-760
• 19 Masoli M, Fabian D, Holt S et al. The global burden of asthma: executive summary of the GINA Dissemination Committee report. Allergy 2004; 59: 469-478
• 20 Poe RH, Kallay MC. Chronic cough and gastroesophageal reflux disease: experience with specific therapy for diagnosis and treatment. Chest 2003; 123: 679-684
• 21 Saritas YukselE, Vaezi MF. Extraesophageal manifestations of gastroesophageal reflux disease: cough, asthma, laryngitis, chest pain. Swiss Med Wkly 2012; 142: w13544
• 22 Kardos P, Berck H, Fuchs KH et al. Guidelines of the german respiratory society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie 2010; 64: 336-373
• 23 Merschhemke M. Gastro-esophageal reflux disease and extra-esophageal diseases [MD]. Freie Universität Berlin 2008
• 24 Gastal OL, Castell JA, Castell DO. Frequency and site of gastroesophageal reflux in patients with chest symptoms. Studies using proximal and distal pH monitoring. Chest 1994; 106: 1793-1796