American Board of Internal Medicine (ABIM) Certification Practice Exam

For functional dyspepsia that does not respond to other therapies, what medication class may be effective?

1. Beta-blockers

2. Low-dose tricyclic antidepressants

3. Oral corticosteroids

4. Proton Pump Inhibitors

The correct answer is: Low-dose tricyclic antidepressants

In cases of functional dyspepsia that do not adequately respond to other treatment options, low-dose tricyclic antidepressants have been shown to provide effective relief. Functional dyspepsia is often characterized by persistent pain or discomfort in the upper abdomen without any identifiable physical cause. This condition can be exacerbated by stress and emotional factors, which may influence gastrointestinal function. Low-dose tricyclic antidepressants work by modulating pain perception and can alter gut motility, addressing symptoms of dyspepsia more effectively than traditional gastrointestinal treatments in some patients. They can have a central effect on pain processing and also impact the gastrointestinal system through their interaction with neurotransmitter systems. Other options, such as beta-blockers, oral corticosteroids, and proton pump inhibitors, do not target the underlying pathophysiology of functional dyspepsia in the same way. Beta-blockers primarily manage cardiovascular symptoms rather than gastrointestinal issues. Oral corticosteroids are used for inflammatory conditions, and proton pump inhibitors primarily address acid-related disorders without directly affecting the functional gastrointestinal dysregulation seen in functional dyspepsia. Thus, the use of low-dose tricyclic antidepressants represents a more appropriate therapeutic approach for patients whose symptoms do not improve with standard treatments.