Endoscopic evaluation of refractory gastrointestinal symptoms in pregnant patients unresponsive to conservative and medical therapy

Abstract

Background: Gastrointestinal (GI) symptoms are common in pregnancy, but a subset of patients remains refractory to conservative and medical management. Evidence on the role and outcomes of endoscopy in such patients, particularly in Pakistan, remains limited.
Objective: To evaluate the diagnostic yield and clinical outcomes of endoscopy in pregnant patients with refractory gastrointestinal symptoms that persist despite conservative and medical treatment.
Methods: This prospective observational study was conducted at Combined Military Hospital (CMH), Kharian, Pakistan, from June to August 2025. Pregnant patients with persistent GI symptoms despite conservative and medical therapy were enrolled. Endoscopic procedures were performed under strict maternal-fetal safety protocols. Data on patient demographics, symptom profile, trimester, endoscopic findings, and post-procedure clinical outcomes were systematically collected. Associations between patient characteristics and endoscopic findings were analyzed using chi square test, while symptom improvement before and after endoscopy was assessed with McNemar’s test.
Results: A total of 40 patients were included, with a mean age of 28.4±4.6 years. The most common presenting symptoms were dyspepsia (55%) and nausea/vomiting (35%), while 20% had upper GI bleeding. Endoscopy revealed abnormalities in 29 patients, giving a diagnostic yield of 72.5%. Gastritis (27.5%) and reflux esophagitis (15%) were the most frequent findings, followed by duodenal ulcer (10%), esophageal varices (10%), and Mallory–Weiss tear (5%). Symptom improvement after endoscopy-guided management was significant (100% vs. 25%, p = 0.0001). No maternal or fetal complications were observed.
Conclusion: Endoscopy is a safe and effective diagnostic modality for selected pregnant patients with refractory GI symptoms, enabling timely management and improved clinical outcomes.