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Continuing Medical Education Questions: July 2017: ACG and CAG Clinical Guideline: Management of Dyspepsia

Veerappan, Ganesh R MD, FACG

American Journal of Gastroenterology: July 2017 - Volume 112 - Issue 7 - p 1014
doi: 10.1038/ajg.2017.179
CLINICAL GUIDELINES
Free

1Akron Digestive Disease Consultants, Akron, OH

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Questions:

  1. 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.
  2. 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.
  3. 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.
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