Continuing Medical Education Questions: July 2017: ACG and CAG Clinical Guideline: Management of DyspepsiaVeerappan, Ganesh R MD, FACGAmerican Journal of Gastroenterology: July 2017 - Volume 112 - Issue 7 - p 1014 doi: 10.1038/ajg.2017.179 CLINICAL GUIDELINES Free Author InformationAuthors Article OutlineOutline Article MetricsMetrics 1Akron Digestive Disease Consultants, Akron, OH If you wish to receive credit for this activity, please refer to the Web site:http://acgjournalcme.gi.org/. Questions: Back to Top | Article Outline Questions: A 38-year-old man presents with 3 months of epigastric discomfort associated with decreased appetite. He has no family history of gastric cancer and no blood in his stool. Alarm symptoms are mild weight loss of 5 pounds and mild dysphagia over the last 3 months. He has not had an upper endoscopy, and is not on proton pump inhibitors. He also complains of intermittent nausea.Which one of the following statements is correct, based on the guidelines? A. Upper endoscopy is recommended as part of routine dyspepsia workup. B. Upper endoscopy is recommended due to risk of gastric malignancy. C. Upper endoscopy is not recommended. D. Upper endoscopy is recommended to obtain biopsy evidence of Helicobacter pylori. A 41-year-old woman presents with epigastric discomfort for 6 months. She denies nausea, vomiting, weight loss, blood in stools, melena, dysphagia, or heartburn symptoms. Her primary care physician completed a breath test for H. pylori, which was negative. She was started with empiric once-daily proton pump inhibitor (PPI) therapy with no relief.What is the next step in the management of her dyspepsia, based on the guidelines? A. Trial an alternative drug such as a prokinetic agent or a tricyclic antidepressants. B. Increase PPI to twice daily. C. Switch current PPI to an alternative PPI. D. Recommend endoscopy to work up PPI-refractory dyspepsia. A 60-year-old man presents with new-onset epigastric discomfort for 6 months associated with decreased appetite and nausea. He had a negative upper endoscopy, and was diagnosed with functional dyspepsia. Biopsies during endoscopy and H. pylori tests are negative. He is frustrated that 8 weeks of PPI therapy has not improved symptoms. Prokinetic therapy and TCA therapy have also failed.What is the next step in the management of this patient, based on the guidelines? A. Recommend that the patient try complementary and alternative medicines. B. Order a gastric motility study to diagnose gastroparesis. C. Order a computed tomography scan to evaluate other causes of epigastric discomfort. D. Off er psychological therapies as a treatment for functional dyspepsia. © The American College of Gastroenterology 2017. All Rights Reserved.