American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a reason for repeat endoscopy after PPI therapy for gastric ulcers?

1. New onset of heartburn symptoms

2. Ulcers appearing benign on initial endoscopy

3. Persistent symptoms despite therapy

4. Successful initial endoscopy with clear visualization

The correct answer is: Persistent symptoms despite therapy

Repeat endoscopy after proton pump inhibitor (PPI) therapy for gastric ulcers is primarily indicated when there are persistent symptoms despite therapy. This situation is clinically relevant as it raises concern about the possibility of a more serious underlying condition or complications, such as malignancy or non-healing ulcers. When patients continue to experience symptoms, it warrants further investigation to determine whether the ulcer has not responded to treatment, has evolved into a more complex issue, or perhaps has associated features that were not initially apparent. Persistent symptoms could suggest inadequate healing, potential complications, or even a misdiagnosis, making repeat endoscopy a crucial step in the management of gastric ulcers. The other scenarios do not provide sufficient clinical justification for a repeat endoscopy in the same context. For instance, while new onset of heartburn symptoms could be concerning, it is not directly tied to the status of an existing gastric ulcer. Similarly, ulcers appearing benign on the first endoscopy would typically not necessitate a repeat procedure unless symptoms persisted or other risk factors emerged. Finally, a successful initial endoscopy with clear visualization would usually be a reassuring factor, indicating that a follow-up may not be immediately necessary unless clinical circumstances change.