Peptic ulcer disease (PUD) in pregnancy should be considered separately from PUD in the general population. First, considerable evidence exists that pregnancy alters the clinical presentation and natural history of PUD. For example, the frequency, symptoms, and complication rate of PUD appear to decrease during pregnancy. Second, tests to evaluate suspected PUD that are routine in the general population, including upper gastrointestinal series or esophagogastroduodenoscopy (EGD), must be carefully evaluated during pregnancy for fetal safety. For example, upper gastrointestinal series is contraindicated during pregnancy because of radiation teratogenicity.<sup>12Brent R.L. Radiation teratogenesis Teratology 1980 ;  21 : 281-298 [cross-ref]

Haga clic aquí para ir a la sección de Referencias, 13Brent R.L. The effect of embryonic and fetal exposure to x-ray, microwaves, and ultrasound: Counseling the pregnant and nonpregnant patient about these risks Semin Oncol 1989 ;  16 : 347-368

Haga clic aquí para ir a la sección de Referencias</sup> Third, pregnancy greatly affects PUD therapy. For example, misoprostol is recommended as prophylaxis and treatment of ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs) in the general population but is contraindicated during pregnancy. Fourth, ulcer surgery during pregnancy involves consideration of fetal as well as maternal risks.

The apparently decreased severity of PUD during pregnancy does not decrease the clinical importance of this subject. The clinician commonly treats dyspepsia or pyrosis during pregnancy because of the markedly increased incidence of gastroesophageal reflux disease (GERD) during pregnancy.<sup>22Castro L.P. Reflux esophagitis as the cause of heartburn in pregnancy Am J Obstet Gynecol 1967 ;  98 : 1-10

Haga clic aquí para ir a la sección de Referencias, 90Marrero J.M., Goggin P.M., de Caestecker J.S., y al. Determinants of pregnancy heartburn Br J Obstet Gynaecol 1992 ;  99 : 731-734 [cross-ref]

Haga clic aquí para ir a la sección de Referencias</sup> The clinician commonly elects to prescribe medications for these symptoms, particularly when the symptoms are moderate, without determining the symptom cause because of reluctance to perform invasive tests, such as EGD, during pregnancy. Thus, the clinician has to learn how to treat during pregnancy pyrosis or dyspepsia of undetermined cause, which may be due to either GERD or PUD.

A critical review of PUD during pregnancy is needed to establish what is currently known, to describe what is currently unknown, and to stimulate new research. The literature on PUD during pregnancy suffers from a preponderance of case reports and uncontrolled or poorly controlled studies and a paucity of studies with endoscopically proven PUD. Moreover, most studies are old and predate both the identification of Helicobacter pylori as an important pathogen in PUD and the modern era of endoscopy. This article focuses on how the clinical presentation, natural history, medical therapy, and surgical therapy of PUD differ in pregnancy from that in the general population. This article aims to help the clinician to evaluate, manage, and treat PUD during pregnancy and to stimulate the researcher to perform studies on the role of H. pylori in PUD during pregnancy and to perform studies using appropriate controls and endoscopy to verify the diagnosis of PUD during pregnancy.