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CME QUESTIONS

Continuing Medical Education Questions: November 2021

Chahal, Prabhleen MD, FACG; Saleh, Mohannad Abou MD

Author Information
The American Journal of Gastroenterology: November 2021 - Volume 116 - Issue 11 - p 2171
doi: 10.14309/ajg.0000000000001533
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Abstract

LEARNING OBJECTIVE

Recognize the role of post-reflux swallow-induced peristaltic waves and mean nocturnal baseline impedance in predicting proton pump inhibitor response in patients with chronic cough.

QUESTION 1

A 46-year-old woman with a history of diabetes mellitus is referred to you for suspected gastroesophageal reflux disease (GERD)-related chronic cough. The patient underwent an extensive cardiopulmonary workup that was unrevealing. She describes a non-productive cough that is usually worse in the early morning and after meals. Patient also reports epigastric burning sensation after eating. She denies a history of smoking. You perform an esophagogastroduodenoscopy (EGD) which shows evidence of erosive esophagitis. A 24-hour ambulatory multichannel intraluminal impedance-PH monitoring was also performed. The post-reflux swallow-induced peristaltic wave (PSPW) index was 25%.

Based on this article, which of the following is the strongest predictor of proton pump inhibitor response in this patient?

  • A. History of diabetes mellitus
  • B. Evidence of erosive esophagitis on EGD
  • C. Typical GERD symptoms
  • D. PSPW index of 25%

QUESTION 2

A 52-year-old man with history of anxiety and depression presents to your outpatient clinic for evaluation of chronic cough. Cardiopulmonary evaluation was completed prior to his visit without an identified etiology or improvement in his cough. You perform an esophagogastroduodenoscopy which reveals a normal upper GI tract without evidence of esophagitis. Manometry shows normal peristalsis without underlying esophageal motility issue. A 24-hour ambulatory multichannel intraluminal impedance-PH monitoring was performed. Mean nocturnal baseline impedance was reported to be 1,145 Ω.

What is the next step in managing this patient?

  • A. Prescribe amitriptyline to treat functional dyspepsia
  • B. Prescribe proton pump inhibitor
  • C. Refer to otolaryngology for further evaluation
  • D. Prescribe famotidine at bedtime alone

QUESTION 3

Which of the following is the accurate definition of post-reflux swallow-induced peristaltic wave (PSPW)?

  • A. 50% drop in the impedance originating in the proximal esophagus and reaching the distal lumen within 30 seconds after a reflux event
  • B. 30% drop in the impedance originating in the proximal esophagus and reaching the distal lumen within 30 seconds after a reflux event
  • C. 50% drop in the impedance originating in the proximal esophagus and reaching the distal lumen within 45 seconds after a reflux event
  • D. 30% drop in the impedance originating in the proximal esophagus and reaching the distal lumen within 45 seconds after a reflux event

© 2021 by The American College of Gastroenterology