American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment strategy is appropriate for low-risk gastric ulcers?

1. Immediate surgical intervention

2. Antibiotic therapy

3. Oral PPI therapy with early discharge

4. Long-term corticosteroid therapy

The correct answer is: Oral PPI therapy with early discharge

Oral proton pump inhibitor (PPI) therapy with early discharge is an appropriate treatment strategy for low-risk gastric ulcers. This approach allows for effective management of the ulcer while minimizing hospital stay and associated healthcare costs. PPIs are potent acid suppressants that promote healing of gastric mucosa, reduce gastric acidity, and diminish ulcer-related symptoms. Most low-risk gastric ulcers can be safely managed on an outpatient basis with oral medication, enabling patients to resume normal activities while their ulcer is treated. Immediate surgical intervention is typically reserved for complications or high-risk cases, such as perforation or significant bleeding. Antibiotic therapy is primarily indicated in the treatment of Helicobacter pylori-associated peptic ulcers, but it is not a standalone treatment for all types of gastric ulcers. Long-term corticosteroid therapy could exacerbate gastric ulcers and is generally not recommended as a primary treatment for ulcer healing, especially without a specific indication. Thus, oral PPI therapy provides a balanced and effective approach to managing low-risk gastric ulcers.