19 - 39 yo M with epigastric pain

Question 1

what are the complications of GERD?

Answer 1

• esophagitis
• peptic strictures
• barrett esophagus

Question 2

what is the hallmark of PUD?

Answer 2

epigastric pain that improves with meals

Question 3

epigastric pain that improves with meals is the hallmark of what GI disorder?

Answer 3

PUD

Question 4

what is the empiric treatment strategy for a patient who exhibits the classic symptomatology of GERD with heartburn and regurgitation?

Answer 4

self directed trial of PPI or H2 blocker

Question 5

when should anti-secretory therapy be stopped?

Answer 5

after a successful 4-8 week course

Question 6

what test is most appropriately used when the diagnosis of GERD cant be determined?

Answer 6

24 hour pH probe

Question 7

when should H.pylori testing be initiated?

Answer 7

only in patients with dyspepsia or other upper GI complaints (nausea, epigastric pain)

Question 8

what is triple therapy for H. pylori?

Answer 8

• PPI standard dose BID
• amoxicillin 1g BID
• clarithromycin 500 mg BID

Question 9

what is quad therapy for H. pylori?

Answer 9

• PPI standard dose QD or BID (or ranitidine 150 mg BID)
• metronidazole 250 mg QID
• tetracycline 500 mg QID
• bismuth subsalicylate 525 mg QID

Question 10

what therapy is used for H. pylori in patients who are allergic to amoxicillin?

Answer 10

• PPI
• clarithromycin
• metronidazole

Question 11

what are the best tests to check eradication of H. pylori?

Answer 11

• fecal antigen

- urea breath test

Question 12

what is considered the gold standard for confirming diagnosis of GERD?

Answer 12

24 hour pH probe