American Board of Internal Medicine (ABIM) Certification Practice Exam

When is it indicated to repeat endoscopy for gastric ulcers?

1. After successful treatment

2. Biopsies were previously performed

3. Remaining symptomatic after treatment

4. Evaluation of a family history

The correct answer is: Remaining symptomatic after treatment

Repeating endoscopy for gastric ulcers is indicated when a patient remains symptomatic after treatment. This is crucial as persistent symptoms could suggest that the ulcer has not healed properly, or it may indicate the presence of complications such as bleeding, perforation, or malignancy. Assuring the healing of gastric ulcers is important not only for symptomatic relief but also to rule out any serious underlying conditions that may present similarly. In cases where a patient has completed treatment but is still experiencing symptoms, further evaluation via endoscopy helps to assess the healing status of the ulcer and determine whether further intervention is necessary. It can also help to clarify if there is a different cause for the symptoms, such as gastroesophageal reflux disease or other gastrointestinal disorders. While successful treatment may warrant endoscopy in specific circumstances, such as if there are concerns about complications or if follow-up assessments are needed, the need to investigate ongoing symptoms is a more direct and pressing reason for a repeat endoscopy. Although biopsies were previously performed can be significant in assessing the nature of the ulcer, they don’t automatically necessitate a repeat endoscopy without the context of ongoing symptoms. Family history evaluation typically does not directly influence the decision to repeat endoscopy.