American Board of Internal Medicine (ABIM) Certification Practice Exam

Which strategy significantly reduces the risk of NSAID-induced gastric injury?

1. Monthly endoscopy

2. Standard-dose daily proton pump inhibitor therapy

3. Switching to acetaminophen

4. Combination with antacids

The correct answer is: Standard-dose daily proton pump inhibitor therapy

The strategy of using standard-dose daily proton pump inhibitor (PPI) therapy significantly reduces the risk of NSAID-induced gastric injury due to its mechanism of action in gastric acid suppression. PPIs work by irreversibly inhibiting the H+/K+ ATPase enzyme in the gastric parietal cells, which leads to a profound and sustained decrease in gastric acid secretion. By lowering the acidity of the gastric environment, PPIs not only help prevent the formation of gastric ulcers but also promote the healing of existing ones. This is particularly important for patients who are at higher risk for NSAID-related complications due to the gastric mucosal damage that NSAIDs can cause. PPIs are effective because they address the underlying issue of excessive gastric acid, which is a contributing factor to mucosal injury. While other strategies, such as switching to acetaminophen or combining NSAIDs with antacids, might provide some level of symptom relief or additional protection, they do not offer the same degree of gastroprotection that standard-dose daily PPI therapy provides. Acetaminophen may be safer in terms of gastrointestinal effects but lacks the anti-inflammatory properties of NSAIDs. Antacids can neutralize stomach acid temporarily but do not provide the sustained acid suppression that PPIs