What are the gastro

Hormonal changes during pregnancy result in physiologic changes that affect close to every organ system in the body. These changes are related to 3 major hormones: human chorionic gonadotropin (hCG), progesterone, and estrogen. Because hCG levels peak in the first trimester of pregnancy, hCG has been implicated to be the suspect in the development of nausea and vomiting and hyperemesis gravidarum during pregnancy, but there is no evidence to support this theory.

Normal gastro-intestinal tract functioning changes during pregnancy through several mechanisms. The tone and motility of the stomach are both decreased, and this is most likely due to the smooth musclerelaxing properties of progesterone hormone.

Stomach emptying time is decreased by more than 50% at term, and the lower esophageal sphincter tone is reduced. These factors, along with increasing intra-abdominal pressure from the growing fetus, often lead to heartburn and regurgitation with resultant gastroesophageal reflux disease and heartburn problems- many women find comfort in using tums or Zantac.

Small and large intestinal movement also slow down during pregnancy secondary to the effects of progesterone and estrogen hormones. There is an increase in the water and sodium absorption from the large bowl, which in addition to the transient mechanical obstruction of the large bowl by the growing uterus, can lead to the common symptom of constipation during pregnancy- eating a fiber rich diet usually helps move things along.

The size of the gallbladder increases during pregnancy. Also, the emptying time of the gallbladder is much slower in pregnant women, this is mainly due to the effects of estrogen. During the second and third trimesters of pregnancy, a decrease in the production of some bile acids can increase the risk of gallstones formation and that is why some women have to have their gallbladders taken out during pregnancy or shortly thereafter.

Finally, in the majority of normal pregnancies, the liver does not enlarge, and although signs associated with liver abnormalities are seen during normal pregnancy they frequently disappear soon after delivery and should raise no concern. Also, spider angiomata (which look like bleeding spidering blood vessels under the skin) and palmar erythema ( Redness of the palm of hands) are commonly caused by elevated estrogen levels and typically not by liver pathology, the usual suspected cause, in the pregnant patient.

So there you have it!A quick explanation to the changes that occur in each organof the gastro-intestinal tract during pregnancy. I hope it has demystified some myths.

(GASTROENTEROLOGY 15225720/04,Arleen H et. al.)

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