DIAGNOSTIC EXPLORATIONS IN PREGNANT WOMEN WITH GASTROESOPHAGEAL REFLUX - PowerPoint PPT Presentation

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DIAGNOSTIC EXPLORATIONS IN PREGNANT WOMEN WITH GASTROESOPHAGEAL REFLUX

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diagnostic explorations in pregnant women with gastroesophageal reflux – PowerPoint PPT presentation

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Title: DIAGNOSTIC EXPLORATIONS IN PREGNANT WOMEN WITH GASTROESOPHAGEAL REFLUX


1
DIAGNOSTIC EXPLORATIONS IN PREGNANT WOMEN WITH
GASTROESOPHAGEAL REFLUX
2
Functional digestive disorders have had a long
history, which is scientifically grounded on
research based on increasingly thorough and
precise investigations that make up one of the
main fields of gastroenterological practice.
Kretz Voluson 3D ultrasound
Infrared Isotope Analyser IRIS
Digitrapper Mk III pH- meter


3
The morpho-functional changes occurring in a
womans body during a pregnancy are the
consequence of the body adjusting to the new
requirements triggered by the fetus presence and
needs, which creates a special physiological
state involving the neuro-endocrine, digestive
and metabolic systems.
4
The intensity of the gastroesophageal reflux
(GER) varies depending on the age of the fetus,
increasing progressively as delivery approaches,
and it is influenced by both mechanical (pregnant
uterus) and hormonal (progesterone) factors.
5
Here are the exploration means indicated for
pregnant women suffering from symptomatic GER
  • esophageal pH monitoring,
  • double pH-metryimpedance recording,
  • esophageal (standard and high resolution)
    manometry,
  • upper digestive endoscopy,
  • aspirate investigation,
  • abdominal ultrasound scan,
  • esophageal endoscopic ultrasound scan,
  • gastric emptying scan.

6
Standard esophageal pH-metry may be replaced by
means of pH-metric capsule attached to the
esophagus wall, which record esophageal activity
for 48 to 96 hours, in the absence of a nasal
probe(1). The device is reliable, yet it is less
sensitive to short and light reflux episodes.
pH-metry sensitivity under normal endoscopic
conditions is 40 70.
The recorded pH is transmitted by radiofrequency
signal to a device worn by the patient. The
method measures only acid reflux, not the reflux
volume, and it has low sensitivity in detecting
barely acid postprandrial reflux due to
alimentary gastric plugging.
7
Esophageal pH monitoring is the most
important diagnostic method, which records
esophageal pH for 24 hours, by means of an
electrod located 5 cm above the lower esophageal
sphincter(LES), and it allows assessing
acid/alkaline reflux and the mucosa exposure time
to GER. A study was conducted on 32 pregnant
women who experienced reflux symptoms (heartburn,
acid regurgitations) and who were selected in the
2nd Obstetrics and Gynecology Clinic in Iasi
City, and the results were compared with those of
the control group, which included 30 fertile
women who were not pregnant and had no such
symptoms.
8
GER intensity varies depending on the age of the
fetus, increasing progressively as delivery
approaches. GER intensity is even higher in women
pregnant with twins, due to the disproportionate
uterus volume increase as compared to the
gestational age. pH-metric values become normal
after delivery, which means that GER has a
transitory effect. The most reliable pH-metric
parameter is De Meester score.
DeMeester score variation (depending on the age
of the fetus)
9
2. Bilimetry detects biliary reflux by the
Bilitec method, which employs probes sensitive
to bilirubin concentration thanks to their optic
characteristics (spectrofotometric recording)
when the absorption peak is approximately 450 nm.
10
3. The double pH-metryimpedance recording
reveals the physical nature of gaseous, liquid or
mixed reflux, depending on the electric
conductivity variations occurring between 2
electrodes. Liquid reflux decreases impedance,
whereas gaseous reflux increases it. The
method detects acid (pH lt 4) and non acid (pH gt
7) liquid reflux in the presence of absence of
therapy. In pregnancy, the studies are limited
just for ph-metry.

11
4. Esophageal manometry (EM) records sphincter
tonus and motility alterations by means of a
multi-channel pressure system, which records both
the basal and deglutition pressure of the LES -
normal 15 25 mmHg, - less than 10 GER.
High resolution manometry allows measuring
continuous esophageal motor activity at all
esophageal levels and it detects more often the
motor deficiencies that standard manometry fails
to detect, in particular short intermittent
peristalsis. The LES pressure measurement
and anti-reflux barrier significance were
described and supported in a research presented
at the 4th International Symposium of
Gastrointestinal Motility in Canada.
12
5. Upper digestive endoscopy (UDE) points out the
GER effects on esophageal mucosa. More precisely,
it allows esophagitis staging due to its 95
sensitivity and specificity. UDE is an invasive
method used on certain pregnant women, especially
during the 2nd term of their pregnancy, which is
a clinically calmer period for pregnant women.
13
6. Abdominal ultrasound scanning is the most
adequate imaging method, as it is non-invasive
and able to reveal pregnant uterus increase,
which is perfect for an accurate uterus volume
determination in particular/pathological
circumstances, like for instance twin pregnancy,
fetal macrosomia in diabetes, polyhydramnios,
pregnancy and fibroma.
14
7. Esophageal endoscopic ultrasound scanning is
the only means of recording and measuring the
esophageal wall movements, which proves useful
when the manometric deficiencies are significant.
15
8. Helicobacter pylori (H. pylori) infection may
be detected in pregnant women by C13/C14-urea
breath test (UBT) and by serological tests for H.
pylori antibodies (IgG) the Cisotope test is
non-invasive, stable and nonradioactive. Food
and Drug Administration (FDA) includes UBT in
the C category of tests to be used on pregnant
women.
16
A study was performed on 30 pregnant women in
Gastroenterology Department Iasi and the
prevalence of H. pylori infection detected by
UBT, was 40, less than the one reported for the
East-European countries.
UBT results DOB, delta at 0 and 30 min
17
Conclusion
Thinking fetus
Pregnancy with its particularities
determine GER by increasing level of progesterone
which is produced by the placenta in high
quantities, especially in the 3rd trimester, with
a direct influence in decreasing LES basal
pressure.GER is also provoked by growing the
pregnant uterus with 4 cm monthly, which will
increase the intraabdominal and intragastric
pressure.
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