Peptic ulcer

• Decreased frequency of diagnosis of peptic ulcer disease in pregnancy

• Incidence of ulcer complications in women with known ulcers also reduced in pregnancy

• Symptoms of peptic ulcer disease tend to reduce during pregnancy

• May be related to cessation of smoking & reduced alcohol intake
• May be because symptoms are attributed to 'normal pregnancy symptoms' and pregnant women are less likely to be investigated by endoscopy

• Associated with risk of perforation, haemorrhage and obstruction

• Medical treatment should be with non-absorbable antacids and H2 antagonists. 
Concerns are about anti-androgenic effects of cimetidine on a male fetus

• Relapse rate high because of high prevalence of Helicobacter pylori (85-100%) in peptic ulcer disease

• Therapy for H. pylori infection consists of 10 days to 2 weeks of one or two effective antibiotics, such as amoxicillin, tetracycline (contraindicated in pregnancy), metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. 
The safety of such therapy in pregnancy has not been established

• Ulcer symptoms and complications may increase in the puerparium