Dyspepsia
The ACG recommends _____ for the initial evaluation of dyspepsia in a patient < 60 years with 1 alarm symptom.
What is H. Pylori Testing?
2 Ways PPI can lead to anemia
What is decreased iron and B12 absorption?
What is the treatment for daily heartburn symptoms without alarm symptoms? (include duration)
When can GERD be managed surgically?
What is: PPI failure or with intolerable side effects, desire to stop medication, hiatal hernia
2 subtypes of functional dyspepsia
What are post prandial distress syndrome and epigastric pain syndrome?
What are common side effects of PPI that you should counsel patients on? (hint: these common side effects are not related to absorption)
What are headache, dyspepsia, diarrhea, constipation, bloating?
Provide 3 lifestyle modifications in the management of GERD
What is: weight loss, elevation of head, do not eat the last meal close to bedtime, avoid recumbency immediately after meals. Removal of certain foods may or may not be helpful.
What are three alarm symptoms with heartburn that would prompt evaluation with an EGD? (Must name at least 3 of 4)
What is: dysphagia, weight loss, food impaction, hematemesis, and melena?
Sallie is a 47 yo F with 2 months of epigastric pain associated with nausea. Her stool antigen test is negative for Hpylori. What is the next step in management?
What is an empiric PPI trial?
PPIs cause this type of kidney injury
What is AIN?
Which is the best for the treatment of GERD: esomeprazole, omeprazole, or pantoprazole?
What is non-inferiority?
PPIs vary based on their pharmacokinetics but overall are equally effective on equipotent doses. If patients are refractory on one PPI, it is reasonable to trial a different PPI.
When do patients with GERD (in the absence of other alarm symptoms) need evaluation with an EGD?
What is longstanding GERD of more than 5 years?
A 30-year-old man is evaluated for epigastric pain that is more severe with eating and has progressively worsened over the past 6 months. He has diminished oral intake, as well as occasional nausea and diarrhea. Family history includes stomach cancer in his father. A Helicobacter pylori test is negative, and proton pump inhibitor therapy with omeprazole has been ineffective. His only other medication is loperamide.
On physical examination, vital signs are normal. BMI is 24. The abdomen is tender to palpation. No guarding is noted.
Upper endoscopy findings are normal, as are biopsy specimens obtained from the stomach (for H. pylori) and duodenum (for celiac disease). Omeprazole is discontinued. What is the next best step?
What is a TCA?
Question source: MKSAP 19 qBank
Why do experts believe the evidence for PPI side effects like osteoporosis, CKD, and dementia is weak? What type of studies have been conducted?
What are retrospective observational studies?
What are the three indications for lifelong PPI therapy? (Must answer all 3 correctly)
What is peptic stricture, Barretts esophagus, and significant esophagitis?
Susie has metaplasia without dysplasia on her histopathology from her EGD. When should she get her next EGD?
What is a surveillance endoscopy every 3-5 years?
Who are the two pathologists who discovered HPylori? (partial credit for 1 of 2)
Who are Barry Marshall and Robin Warren?