Baron T H, Ramirez B, Richter J E
University of Alabama, Birmingham.
Ann Intern Med. 1993 Mar 1;118(5):366-75. doi: 10.7326/0003-4819-118-5-199303010-00008.
To review the pathophysiology of gastrointestinal motility disorders during pregnancy, their clinical manifestations, and their management.
Studies published from 1963 to 1992 identified by computerized literature searches of Index Medicus and MEDLINE; hand searches; contact with pharmaceutical representatives for information on drug therapy during pregnancy; and selected texts on drugs and obstetrics.
Selected studies were those involving controlled design of physiology related to pregnancy or to hormonal effects on the gastrointestinal tract or both, and clinical studies or previous reviews that contributed to the understanding of the gastrointestinal effects of pregnancy.
Data concerning the epidemiology, causes, clinical manifestations, and complications of altered gastrointestinal motility during pregnancy as well as the strength of association between gastrointestinal disorders of pregnancy and hormonal changes were evaluated and used to develop a practical approach to evaluate and manage these patients.
Effects on the gastrointestinal tract during pregnancy are caused primarily by hormonal changes and not the physical effects of the gravid uterus. Motility changes occur throughout the gastrointestinal tract, including a reduction in lower esophageal sphincter pressure and its physiologic function with resulting gastroesophageal reflux and the risk for aspiration; alterations in gastric motor function associated with nausea and vomiting; and a decrease in the rate of small-bowel and colonic transit manifested primarily as abdominal bloating and constipation. These effects are mediated by progesterone, with estrogen probably acting as a primer.
Given the large number of pregnancies each year complicated by gastrointestinal motility disorders, many physicians (including internists and gastroenterologists) must manage these problems. Knowledge of the underlying physiologic alterations in gastrointestinal motility during pregnancy and of safe treatment options is essential to the care of the pregnant patient.
综述妊娠期胃肠动力障碍的病理生理学、临床表现及其处理。
通过对《医学索引》和《医学期刊数据库》进行计算机文献检索，检索出1963年至1992年发表的研究；手工检索；与制药代表联系以获取妊娠期药物治疗的信息；以及选定的药物和产科学教科书。
选定的研究包括涉及与妊娠相关的生理学或激素对胃肠道影响或两者兼有的对照设计研究，以及有助于理解妊娠对胃肠道影响的临床研究或既往综述。
评估有关妊娠期胃肠动力改变的流行病学、病因、临床表现和并发症的数据，以及妊娠胃肠疾病与激素变化之间的关联强度，并用于制定评估和处理这些患者的实用方法。
妊娠期对胃肠道的影响主要由激素变化引起，而非妊娠子宫的物理影响。整个胃肠道均出现动力改变，包括食管下括约肌压力及其生理功能降低，导致胃食管反流和误吸风险增加；与恶心和呕吐相关的胃运动功能改变；小肠和结肠转运速率降低，主要表现为腹胀和便秘。这些影响由孕酮介导，雌激素可能起启动作用。
鉴于每年有大量妊娠合并胃肠动力障碍，许多医生（包括内科医生和胃肠病学家）必须处理这些问题。了解妊娠期胃肠动力的潜在生理改变以及安全的治疗选择对于照顾妊娠患者至关重要。
