ACG Gastrointestinal Disease Diagnosis and Management 1 — Questions and Answers
Question 1: According to ACG guidelines, what is the preferred first-line regimen for Helicobacter pylori eradication in regions with high clarithromycin resistance?
- Clarithromycin-based triple therapy for 7 days
- Bismuth quadruple therapy for 10-14 days (Correct answer)
- Amoxicillin monotherapy for 14 days
- Levofloxacin dual therapy for 5 days
Correct answer: Bismuth quadruple therapy for 10-14 days
ACG guidelines recommend bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline) for 10-14 days as the preferred first-line regimen in areas with high clarithromycin resistance.
Question 2: A 55-year-old with long-standing GERD undergoes endoscopy revealing Barrett's esophagus without dysplasia. Per ACG guidelines, what is the recommended surveillance interval?
- Every 6 months
- Every 1 year
- Every 3-5 years (Correct answer)
- No further surveillance needed
Correct answer: Every 3-5 years
ACG guidelines recommend surveillance endoscopy every 3-5 years for Barrett's esophagus with no dysplasia, as the risk of progression to adenocarcinoma is low.
Question 3: Which endoscopic finding best distinguishes Crohn's disease from ulcerative colitis on colonoscopy?
- Continuous mucosal inflammation from the rectum
- Pseudopolyps in the sigmoid colon
- Skip lesions with rectal sparing (Correct answer)
- Mucosal friability and bleeding
Correct answer: Skip lesions with rectal sparing
Skip lesions with rectal sparing are characteristic of Crohn's disease, while ulcerative colitis typically shows continuous inflammation starting from the rectum.
Question 4: What is the recommended first-line serologic test for diagnosing celiac disease in a patient actively consuming gluten?
- Anti-endomysial antibody (EMA-IgA)
- IgA tissue transglutaminase antibody (tTG-IgA) (Correct answer)
- Anti-gliadin antibody (AGA-IgG)
- Deamidated gliadin peptide IgG (DGP-IgG)
Correct answer: IgA tissue transglutaminase antibody (tTG-IgA)
IgA tTG antibody is the recommended first-line serologic test for celiac disease diagnosis due to its high sensitivity and specificity when the patient is on a gluten-containing diet.
Question 5: According to updated ACG guidelines, at what age should colorectal cancer screening with colonoscopy begin for average-risk adults in the US?
- Age 40
- Age 45 (Correct answer)
- Age 50
- Age 55
Correct answer: Age 45
ACG guidelines updated in 2021 recommend colorectal cancer screening beginning at age 45 for average-risk adults, lowering the threshold from the previously recommended age of 50.
Question 6: Which scoring system uses clinical and laboratory parameters assessed at admission and at 48 hours to stratify severity of acute pancreatitis?
- Child-Pugh score
- Ranson criteria (Correct answer)
- APACHE II score
- Glasgow-Blatchford score
Correct answer: Ranson criteria
The Ranson criteria assess acute pancreatitis severity using 5 parameters at admission and 6 additional parameters at 48 hours, with a score of 3 or more indicating severe disease.
Question 7: A patient presents with dysphagia, food impaction, and peripheral eosinophilia. Endoscopy shows esophageal rings and furrows with 20 eosinophils/HPF on biopsy. What is the most likely diagnosis?
- Gastroesophageal reflux disease (GERD)
- Eosinophilic esophagitis (EoE) (Correct answer)
- Achalasia
- Esophageal candidiasis
Correct answer: Eosinophilic esophagitis (EoE)
Eosinophilic esophagitis is diagnosed by esophageal symptoms, characteristic endoscopic findings (rings, furrows, exudates), and ≥15 eosinophils per high-power field on biopsy after PPI trial.
ACG Gastrointestinal Disease Diagnosis and Management 1
According to ACG guidelines, what is the preferred first-line regimen for Helicobacter pylori eradication in regions with high clarithromycin resistance?