American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with bleeding peptic ulcer disease (PUD), what test should be performed as a second test alongside the endoscopic or fecal antigen test?

1. Serologic antibody testing

2. H. pylori breath test

3. Stool sample analysis

4. Upper gastrointestinal series

The correct answer is: Serologic antibody testing

In the context of managing bleeding peptic ulcer disease (PUD), particularly when there is a concern for Helicobacter pylori (H. pylori) infection, it’s vital to confirm the diagnosis of this bacterium as it is often implicated in the pathogenesis of PUD. While endoscopic and fecal antigen testing are commonly used for this purpose, serologic antibody testing serves as a complementary method that can aid in diagnosis. Serologic antibody testing detects the presence of antibodies against H. pylori in the blood, which indicates an immune response to an infection. However, it is essential to note that serologic tests may remain positive even after successful eradication of the infection, which can complicate interpretation. Despite this limitation, this method is non-invasive, relatively quick, and can provide useful information in conjunction with either endoscopy or fecal antigen tests when diagnosing H. pylori in patients with bleeding ulcers. The other testing options, while relevant in different scenarios, do not function as effective second tests alongside endoscopic or fecal antigen tests. The H. pylori breath test, for instance, is non-invasive and effective but isn’t typically combined with the aforementioned tests in the acute setting of bleeding. Stool sample analysis provides qualitative data but