Gastrointestinal diseases during pregnancy: what does the gastroenterologist need to know?

Abstract

Pregnancy is characterized by numerous physiological changes that may lead to a diversity of symptoms and frequently to gastrointestinal complaints, such as heartburn, nausea and vomiting, or constipation. Chronic gastrointestinal diseases require treatment maintenance during this period, raising the challenging question whether outcomes beneficial to the mother may be harmful for the fetus. In addition, certain diseases, such as acute fatty liver of pregnancy, only develop during pregnancy and may require urgent procedures, such as fetus delivery. Even though they are not present in our day-to-day practice, knowledge of pregnancy-related diseases is fundamental and collaboration between gastroenterologists and obstetricians is often necessary. Herein, we review pregnancy-related diseases and systematize the most appropriate treatment choices according to the recent literature and guidelines, so that the article can serve as a guide to the gastroenterologist regarding the medical approach to pregnancy-related gastrointestinal and liver diseases and their therapeutic management.

Keywords: Pregnancy; endoscopy; gastrointestinal symptoms; inflammatory bowel disease; liver; management; treatment.

Figure 1

Approach to abnormal liver test during pregnancy. Firstly, exclude anomalies otherwise explained by physiologic changes during pregnancy (elevation of alkaline phosphatase). Then, for a cholestasis profile, mechanical causes of biliary obstruction need to be excluded. If imaging exams are within normal or the patient has a hepatocellular profile, rule out coincidental causes (medication, viral hepatitis). For multisystem involvement in liver diseases unique to pregnancy, consider AFLP (signs of hepatic dysfunction) or preeclampsia. Exclude HELLP syndrome. Pruritus without multisystem involvement leads to ICP AFLP, acute fatty liver of pregnancy; HELLP, hemolysis, elevated liver enzymes and low platelet count; ICP, intrahepatic cholestasis of pregnancy; AST, aspartate aminotransferase; ALT, alanine aminotransferase; GGT, γ-glutamyl transferase; LDH, lactate dehydrogenase; PT, prothrombin time; APTT, activated partial thromboplastin time.