ACG Gastrointestinal Disease Diagnosis and Management 2 — Questions and Answers
Question 1: According to the Rome IV criteria, which symptom pattern is required for the diagnosis of irritable bowel syndrome (IBS)?
- Recurrent abdominal pain at least 1 day/week for the last 3 months associated with defecation or stool changes (Correct answer)
- Daily abdominal cramping with alternating diarrhea and constipation for at least 6 months
- Bloating and flatulence occurring more than 3 days/week without structural disease
- Loose stools after every meal for at least 1 month with no organic cause identified
Correct answer: Recurrent abdominal pain at least 1 day/week for the last 3 months associated with defecation or stool changes
Rome IV criteria define IBS as recurrent abdominal pain at least 1 day per week in the last 3 months, associated with ≥2 of the following: relation to defecation, change in stool frequency, or change in stool form.
Question 2: What is the current standard of care for treatment-naive chronic hepatitis C with genotype 1 in the United States?
- Pegylated interferon plus ribavirin for 48 weeks
- Pan-genotypic direct-acting antiviral (DAA) combination therapy for 8-12 weeks (Correct answer)
- Sofosbuvir monotherapy for 12 weeks
- Ribavirin monotherapy with close virologic monitoring
Correct answer: Pan-genotypic direct-acting antiviral (DAA) combination therapy for 8-12 weeks
Pan-genotypic DAA combinations such as sofosbuvir/velpatasvir or glecaprevir/pibrentasvir for 8-12 weeks are the current standard of care, achieving sustained virologic response in over 95% of patients.
Question 3: Which test is considered the gold standard for diagnosing gastroparesis?
- Upper endoscopy with retained food assessment
- Abdominal CT scan with oral contrast
- Gastric emptying scintigraphy with a standardized solid meal (Correct answer)
- Wireless motility capsule pH measurement
Correct answer: Gastric emptying scintigraphy with a standardized solid meal
Gastric emptying scintigraphy using a technetium-99m labeled standardized solid meal measured at 1, 2, and 4 hours is the gold standard for diagnosing gastroparesis.
Question 4: A hemodynamically stable patient with mild uncomplicated acute diverticulitis (Hinchey Stage Ia) is managed as an outpatient. Which initial approach is supported by ACG guidelines?
- Emergency laparoscopic sigmoid resection
- Intravenous antibiotics with hospital admission for 72 hours
- Oral antibiotics or observation without antibiotics (Correct answer)
- Urgent colonoscopy within 24 hours to assess severity
Correct answer: Oral antibiotics or observation without antibiotics
ACG guidelines support outpatient management with oral antibiotics or even observation alone for mild uncomplicated acute diverticulitis in immunocompetent, low-risk patients.
Question 5: Which non-invasive index is recommended by ACG as the preferred first-line tool for assessing liver fibrosis stage in patients with NAFLD?
- AST/ALT ratio
- FIB-4 score (Correct answer)
- NAFLD Fibrosis Score (NFS)
- APRI score
Correct answer: FIB-4 score
The FIB-4 score, calculated from age, AST, ALT, and platelet count, has been validated as an accurate non-invasive test for significant liver fibrosis in NAFLD and is ACG's recommended first-line assessment.
Question 6: A 70-year-old patient with overt GI bleeding undergoes capsule endoscopy revealing an actively bleeding arteriovenous malformation (AVM) in the mid-jejunum. What is the preferred therapeutic approach?
- Surgical resection of the affected small bowel segment
- Repeat capsule endoscopy in 4 weeks
- Device-assisted enteroscopy with endoscopic hemostasis (Correct answer)
- Transcatheter angiographic embolization as first-line therapy
Correct answer: Device-assisted enteroscopy with endoscopic hemostasis
Device-assisted enteroscopy (balloon-assisted or spiral enteroscopy) allows direct visualization and endoscopic treatment of small bowel lesions such as AVMs, making it the preferred approach after capsule endoscopy localizes the source.
Question 7: Which annual stool-based test is recommended by ACG as a non-invasive colorectal cancer screening option for average-risk patients?
- Guaiac fecal occult blood test (gFOBT) every 3 years
- Fecal immunochemical test (FIT) annually (Correct answer)
- Stool DNA test (Cologuard) every 1 year
- Fecal calprotectin test annually
Correct answer: Fecal immunochemical test (FIT) annually
ACG recommends annual fecal immunochemical testing (FIT) as a non-invasive CRC screening option; it is more sensitive and specific than guaiac FOBT and requires no dietary restrictions.
ACG Gastrointestinal Disease Diagnosis and Management 2
According to the Rome IV criteria, which symptom pattern is required for the diagnosis of irritable bowel syndrome (IBS)?