American Board of Internal Medicine (ABIM) Certification Practice Exam

What is an alternative treatment for NSAID-induced gastric injury, though it may have limiting side effects?

1. High-dose aspirin

2. Misoprostol

3. Colloidal bismuth

4. Amoxicillin

The correct answer is: Misoprostol

Misoprostol is an alternative treatment for NSAID-induced gastric injury because it has the ability to protect the gastric mucosa. This synthetic prostaglandin E1 derivative promotes the secretion of mucus and bicarbonate, enhances mucosal blood flow, and reduces gastric acid secretion, thereby helping to prevent and heal gastric ulcers associated with NSAID use. While the use of misoprostol can be effective, it is important to note that it may have limiting side effects, including gastrointestinal cramping and diarrhea, which can make its use less tolerable for some patients. Because of these potential side effects, cautious consideration must be taken when prescribing it, especially for patients who may already be experiencing GI discomfort. The other treatments listed do not effectively provide the same protection against NSAID-induced gastric injury. High-dose aspirin would actually increase the risk of gastric injury instead of providing protection. Colloidal bismuth can provide a protective coating for the gastric mucosa but is generally not as effective as misoprostol in directly addressing the multifactorial mechanisms of NSAID-induced injury. Amoxicillin does not have any protective effect on gastric mucosa and is primarily an antibiotic used to treat infections. Thus, misoprostol stands out for its specific