I was diagnosed with GERD five years ago. I have scar tissue around my lower esophageal sphincter muscle, as well as esophagitis. I know what to do to manage my condition -- I eat small meals of bland foods, stay a little underweight, etc. I have been on 40mg of Pepcid twice a day for years, plus Prilosec during bad flare-ups. My most recent flareup occurred after taking doxycycline, which caused me to spit up blood. My question is this: I'm 29 and considering having children, but I know that many women with no digestive complaints suffer from severe heartburn during pregnancy. I am worried how a pregnancy might affect me given that I already have GERD. I am also afraid of what complications might arise: more bleeding, scar tissue, etc. Then there is the issue of whether I could take my medication during pregnancy. What are your thoughts?

Michelle

First of all, you should be aware that your GERD can be effectively controlled, and the effects of esophagitis -- and maybe even the scarring -- reduced by effective medical therapy or with surgery. Medical treatment would include drugs designed to reduce acid production; we usually treat people with GERD as severe as yours with proton-pump inhibitors (Prilosec or Prevacid). Surgical treatment would involve a procedure called a laparoscopic nissen fundoplication. This operation can be done through a few tiny slits in the skin, with a short hospitalization and minimal recovery time. Success rates are over 90 percent.

You are correct that pregnancy might worsen your symptoms. The medications you are on have not been studied well enough in humans to be sure they are absolutely safe during pregnancy, though when absolutely necessary they are used. There are agents -- antacids and sucralfate (carafate) -- that are safer because they involve little absorption into the bloodstream. If your symptoms are this severe and you must be on Prilosec or Pepcid, you may want to consider surgery before you become pregnant.