Dyspepsia and Reflux Mana...

A 27-year-old woman in her second pregnancy trimester presented to her gastroenterologist with complaints of recurrent epigastric pain, bloating, and belching. She also reported a history of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) with constipation. After a thorough evaluation, she was diagnosed with dyspepsia with comorbidities and given a Rome IV criteria-based diagnosis of postprandial distress syndrome (PDS) and functional constipation. She also had erosive esophagitis on gastroscopy, graded as Los Angeles Classification grade B as shown in figure 01. To further evaluate her symptoms, she underwent multichannel intraluminal impedance (MII) monitoring, which revealed frequent non-acid reflux events and a high number of weakly acidic reflux events, consistent with her symptoms of dyspepsia and GERD.

Initially, a combination of antacids, prokinetic agents, and laxatives was prescribed to control her symptoms. However, after two weeks of treatment, she reported only a slight improvement in her symptoms, particularly her postprandial distress symptoms. She was then switched to sodium alginate for two weeks, and her GERD symptom score decreased to 14, and her postprandial distress symptoms improved significantly. She also reported improvement in her constipation symptoms. She continued taking sodium alginate for the rest of her pregnancy, and her dyspepsia symptoms remained well-controlled.