American Board of Internal Medicine (ABIM) Certification Practice Exam

How should low-risk ulcers found on endoscopy be managed?

1. Immediate surgical referral

2. Oral PPI therapy with allowance for food

3. Admission for intravenous therapy

4. Observation without treatment

The correct answer is: Oral PPI therapy with allowance for food

The management of low-risk ulcers found during endoscopy typically involves the use of oral proton pump inhibitors (PPIs). This approach is based on the understanding that PPIs promote ulcer healing by reducing gastric acid secretion, which allows the ulcer to heal more effectively. Allowing for food intake while on oral PPI therapy does not hinder the healing process and can be beneficial for patients, as they might find it more comfortable to eat. In contrast, immediate surgical referral is generally reserved for high-risk or complicated ulcers, such as those with suspected malignancy or perforation. Intravenous therapy is typically unnecessary for low-risk ulcers, where oral medications are sufficient. Observation without treatment might be considered in certain low-risk scenarios, but offering a therapeutic intervention like PPI therapy is more prudent to actively promote healing and prevent complications. Thus, managing low-risk ulcers with oral PPI therapy is the most appropriate and effective strategy.