American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for systemic sclerosis-associated malabsorption due to bacterial overgrowth?

1. Dietary modifications

2. Rotating courses of antibiotics

3. Probiotics supplementation

4. Intravenous immunoglobulin therapy

The correct answer is: Rotating courses of antibiotics

The recommended treatment for systemic sclerosis-associated malabsorption due to bacterial overgrowth is to use rotating courses of antibiotics. In patients with systemic sclerosis, gastrointestinal involvement can lead to hypomotility and increased risk of small intestinal bacterial overgrowth (SIBO). This overgrowth can result in malabsorption, contributing to nutritional deficiencies and other gastrointestinal symptoms. Antibiotics are effective in addressing the bacterial overgrowth, and rotating different antibiotics can help prevent the development of antibiotic resistance, improve gut flora, and enhance the chances of resolution of the symptoms associated with malabsorption. This approach targets the underlying cause of the malabsorption, rather than just alleviating its manifestations. In many cases, the use of antibiotics leads to significant improvements in intestinal function and nutrient absorption, addressing the critical complications associated with systemic sclerosis. While dietary modifications and probiotics are important for overall gut health, they may not sufficiently tackle the bacterial overgrowth specifically. Intravenous immunoglobulin therapy is typically used for immunodeficiency issues and does not directly address the bacterial overgrowth causing malabsorption in Systemic sclerosis. Thus, the use of rotating courses of antibiotics is the most direct and effective treatment for this condition.