American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommendation for patients who might have esophagogastric varices?

1. None if they are asymptomatic

2. Endoscopic screening

3. Medication therapy alone

4. Surgical intervention

The correct answer is: Endoscopic screening

The recommendation for patients who might have esophagogastric varices is endoscopic screening. This is critical because esophagogastric varices can be a serious complication of portal hypertension, often seen in patients with chronic liver disease, particularly cirrhosis. Endoscopic screening is recommended to identify the presence of varices before they cause significant problems, such as bleeding. The importance of this recommendation lies in its role in preventive medicine. Once varices are identified, appropriate prophylactic measures can be taken, including the potential for endoscopic band ligation or the initiation of beta-blocker therapy to reduce the risk of bleeding. The goal of endoscopic screening is to monitor the progression of portal hypertension and to intervene before life-threatening complications occur. Asymptomatic patients may still have varices that are at risk for bleeding, which is why relying solely on the absence of symptoms is not adequate. Therefore, routine screening through endoscopy is essential for identifying at-risk patients and managing them effectively. This proactive approach is pivotal in reducing morbidity and mortality associated with variceal hemorrhage.