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A painful, burning feeling in the chest caused by stomach acid flowing back into the esophagus.

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Heartburn affects more than two‐thirds of women in late pregnancy. Usually it is not serious, but symptoms can be very distressing to pregnant women. There are many different interventions to relieve heartburn including advice on diet and lifestyle and a range of medicines (many of which are available over the counter without prescription). The review authors identified three randomised controlled trials including a total of 286 women focusing on three different heartburn medications. While the results of the individual trials were positive (women described some relief from symptoms), overall it was concluded that there is little information on the safety or effectiveness of drugs used to treat heartburn in pregnancy. More information is needed on this common and distressing condition.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

If it is thought that someone might have GERD, treatment with a proton pump inhibitor can be tried out. If this relieves the symptoms, then it is very likely that GERD is causing them. Further tests might be necessary if there is no clear outcome or if the person has unusual symptoms.A lot of people have heartburn after large meals. Occasional acid reflux is normal too. But very frequent, severe heartburn or acid reflux can be a sign of gastro-esophageal reflux disease, or GERD for short. In GERD, some of the stomach contents flow back into the food pipe because the entrance to the stomach doesn't close properly.It is usually typical symptoms like these that make people seek medical advice. Sometimes people have an examination because of other symptoms, and then discover by chance that their food pipe is inflamed. The food pipe can become inflamed if the mucous membranes lining it are repeatedly exposed to acidic stomach juices.Describing your symptoms in as much detail as possible is important when it comes to diagnosing GERD:What symptoms do you have?Where exactly are they?How often do you have them?Do the symptoms occur after eating or when your stomach is empty?Do they get worse when you lie down?This information can help the doctor to find out whether the symptoms are being caused by GERD or by something else.GERD doesn't always cause obvious symptoms. For instance, someone might have GERD without having heartburn or acid reflux, or these symptoms may only be very infrequent or mild. Or they may have other, less typical symptoms, such as problems swallowing, a sore throat or a cough.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 18, 2015

Patients with only mild or intermittent heartburn may have adequate relief with lifestyle modifications and with antacids, although other options are available. The two most commonly used drugs for treatment of heartburn are H2‐receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). These drugs act by suppressing the release of acid from the stomach. This review found that in the short term PPIs relieve heartburn better than H2RAs in patients who are treated without specific diagnostic testing. Although the difference is smaller, this is also true for patients with gastro‐oesophageal reflux disease (GORD), who have a normal upper endoscopy . In summary, proton pump inhibitor drugs appear to be more effective than H2‐receptor antagonists for relieving heartburn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Many people will be familiar with the burning pain that spreads from their upper stomach into their throat, accompanied by a bitter taste in their mouths. In gastro-esophageal reflux disease (GERD), these symptoms are frequent and severe. They may also be accompanied by other symptoms such as problems swallowing, a burning throat and a cough.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 18, 2015

Typical symptoms of GERD, such as heartburn and acid reflux, can sometimes be relieved by changing your diet. Effective medications are also available. Surgery might be considered in some cases.Many people have heartburn every now and again after eating a large meal, and will be familiar with the unpleasant burning feeling in their chest, just behind their breastbone. Occasional acid reflux is normal too. But if you often experience acid reflux, have severe heartburn, and it is having a big effect on your everyday life, you may have what is known as “gastro-esophageal reflux disease”, or GERD for short. Reflux is where some of the contents of your stomach leak out and flow back into your food pipe because the entrance to your stomach doesn't close properly.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: November 18, 2015

This review aims to evaluate the effectiveness of interventions for relieving heartburn in pregnancy. Interventions include advice on diet, lifestyle modification, medications and complementary therapies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Gastro‐oesophageal reflux disease or GORD is a condition which develops when stomach contents regurgitate into the oesophagus causing troublesome symptoms such as heartburn (burning sensation at the lower end of the breastbone) or regurgitation (perception of flow of stomach content into the throat or mouth). Long‐term complications of GORD include reflux oesophagitis (injury to lining of oesophagus), bleeding from the oesophagus, narrowing of the oesophagus, change in the nature of the lining of the oesophagus which can sometimes give rise to oesophageal cancer. Approximately 3% to 33% of people have GORD around the world. The risk factors for GORD include a family history of reflux disease in immediate relatives, pregnancy, older age, obesity, cigarette smoking, and excessive alcohol drinking. Apart from lifestyle changes (such as cessation of smoking) and diet changes (avoiding food that causes heartburn), the major forms of treatment for GORD are medical and surgical. The medical treatment is usually aimed at decreasing acidity in the stomach. Currently a group of drugs which suppress acid secretion, called proton pump inhibitors, are considered the best in decreasing acid secretion. The main surgical treatment is fundoplication which involves wrapping around the lower part of the food pipe with stomach. This can be performed by traditional open surgery, keyhole surgery or surgery that is performed without making any cut from within the stomach with the help of an endoscope (in this context, a flexible tube introduced through the mouth to give a view of the food pipe and stomach). The benefits and harms of laparoscopic fundoplication compared to medical treatment in people with GORD is not known. We sought to resolve this issue by searching for existing studies on the topic. We included all studies whose results were reported until 1st October 2014.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

This review assessed proton-pump inhibitors for the relief of heartburn within 1 to 2 days. The authors concluded that proton pump inhibitors may improve symptoms within 24 hours, but most patients will not experience relief in the first 1 or 2 days. Apart from the limited search, this was a well-conducted review and the authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2005

INTRODUCTION: Unexplained chest pain is potentially attributable to gastro-oesophageal reflux disease (GORD) or oesophageal motility disorders. Reflux chest pain may occur without heartburn. We explored the response of unexplained chest pain to proton pump inhibitor (PPI) therapy in randomised clinical trials (RCTs), differentiating patients with and without objective evidence of GORD.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

BACKGROUND: Various reconstruction procedures have been proposed for restoring the alimentary tract continuity after total gastrectomy. However, so far there is no consensus on the ideal post-gastrectomy reconstruction procedure. The necessity of preserving the duodenal passage is one of the major focuses of the debate concerning gastrointestinal reconstruction and is the objective of this study.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Many pregnant women who have asthma worry that their medication might harm their child. But most asthma medications are considered to be safe in pregnancy too. Untreated asthma, on the other hand, can have serious consequences.It is estimated that about 1 out of 5 pregnant women with asthma need treatment for asthma attacks. But good asthma control, particularly with the regular use of inhaled corticosteroids, can prevent these attacks. And there are a number of things you can do to avoid possible triggers of asthma attacks.In many women who have asthma, being pregnant does not affect their symptoms. Their symptoms sometimes even get better at first. But the physical changes that happen during pregnancy make asthma worse in 1 out of 3 women. Towards the end of pregnancy it often becomes increasingly difficult to stay physically active. Carrying the extra weight around can even make women who do not have asthma feel out of breath. Many cannot sleep properly, and feel tired and exhausted.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: February 26, 2014

Proton pump inhibitors decrease secretion of gastric acid. They act by blocking the last enzyme in the system that actively transports acid from gastric parietal cells into the gastrointestinal lumen, hydrogen–potassium adenosine triphosphatase, also known as the proton pump. Omeprazole, the first drug in this class, was introduced in 1989. Since then, 4 other proton pump inhibitors have been introduced: lansoprazole (1995), rabeprazole (1999), pantoprazole (2000), and esomeprazole (2001). In 2003 omeprazole became available over-the-counter in the United States. The purpose of this review is to compare the benefits and harms of different PPIs.

Drug Class Reviews - Oregon Health & Science University.

Version: May 2009

How do proton pump inhibitors compare in gastroesophageal reflux disease (GERD)?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

This review concluded that proton pump inhibitor use during early pregnancy was not associated with an increased risk for major congenital birth defects, spontaneous abortions and preterm delivery. In light of uncertainty over generalisability and parts of the review process, plus the potential influence of one large study, the reliability of the authors' conclusions is unclear.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This review concluded that histamine 2 blockers can be used safely in pregnancy. These conclusions were supported by the results presented, but should be interpreted with caution as very few details were provided on the participants in the included studies and on methodological quality.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2009

This review assessed the use of proton-pump inhibitors (PPIs) to relieve the symptoms of nonerosive reflux disease (NERD). The authors concluded that PPIs have a lesser effect in NERD than in erosive oesophagitis, and that symptoms tended to improve throughout the 4-week period. Insufficient data were presented to assess the appropriateness of pooling the studies, hence any conclusions may not be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

The review concluded that short gastric vessel division during laparoscopic Nissen fundoplication was associated with longer operative time and hospital stay. No differences in functional outcomes were found at one and 10 years follow-up. Limitations of the evidence base (only a few small and low quality trials) mean that the conclusions should be regarded as provisional.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

The review concluded that patient satisfaction was high with medication for gastroesophageal reflux disease and particularly for proton pump inhibitors (more than 70%). There was also a positive association between patient satisfaction and symptom resolution and health-related quality of life. Potential limitations to study quality and the review process imply the authors' conclusions should be treated with caution.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

This review assessed the accuracy of symptomatic response to proton-pump inhibitor (PPI) treatment in the diagnosis of gastroesophageal reflux disease (GERD). The authors concluded that a response to short-term treatment with PPIs does not accurately diagnose GERD as defined by traditional objective criteria. The authors' conclusions are likely to be reliable.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2004

To assess the evidence for the efficacy of the following interventions for improving clinical outcomes in adults with osteoarthritis (OA) of the knee: cell-based therapies; glucosamine, chondroitin, or glucosamine plus chondroitin; strength training, agility, or aerobic exercise (land or water based); balneotherapy, mud bath therapy; electrical stimulation techniques (including transcutaneous electrical stimulation [TENS], neuromuscular electrical stimulation, and pulsed electromagnetic field therapy [PEMF]); whole body vibration; heat, infrared, or ultrasound; orthoses (knee braces, shoe inserts, or specially designed shoes); weight loss diets; and home-based therapy or self-management.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: May 2017

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