Clinical utility of esophagogastroduodenoscopy in the management of recurrent and intractable vomiting in pregnancy

OBJECTIVE: To determine the impact of esophagogastroduodenoscopy (EGD) on the clinical management of pregnancy women with recurrent vomiting and their pregnancy outcome. STUDY DESIGN: Retrospective evaluation of 60 pregnant women who underwent diagnostic EGD in the first trimester of pregnancy. RESULTS: Pregnant women were divided into 2 groups according to the indications for EGD: group 1, intractable vomiting with or without epigastric pain (n = 49) and group 2, vomiting and gastrointestinal bleeding (n = 11). The endoscopic findings found in both groups were esophagitis (43%), gastritis (17%), diaphragmatic hernia (17%) and normal EGD (28%). The diagnostic yield for EGD was 69% for group 1 and 82% for group 2. EGD was helpful for clinical management when performed for suspected gastrointestinal bleeding rather than for other indications. Mean gestational age at delivery, fetal weight and mean Apgar score did not differ by groups. No fetal malformations were observed. CONCLUSION: Recurrent intractable vomiting in pregnancy may be accompanied by esophagitis or peptic disease in a significant proportion of patients. Based on the significant pathologies amenable to medical therapy, a therapeutic trial with a proton pump inhibitor during hyperemesis gravidarum seems warranted. EGD can be safely performed in pregnancy with no maternal or fetal complications.