American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with gastroesophageal reflux disease who partially respond to proton pump inhibitor therapy, what is the recommended course of action?

1. Increase the dosage to twice daily

2. Switch to a different class of medications

3. Advise dietary modifications only

4. Perform esophageal manometry

The correct answer is: Increase the dosage to twice daily

In cases where patients with gastroesophageal reflux disease (GERD) demonstrate only a partial response to proton pump inhibitor (PPI) therapy, the recommended course of action is to increase the dosage to twice daily. This approach is founded on the understanding that many patients may not achieve adequate symptom control on standard once-daily PPI dosing. PPIs are highly effective at reducing gastric acid secretion and providing relief from reflux symptoms. However, the degree of acid suppression can vary significantly among individuals. By doubling the dose, you can enhance the acid suppression further, potentially leading to improved symptom management and healing of esophagitis. Other options such as switching to a different class of medications, advising dietary modifications only, or conducting esophageal manometry may be considered in specific scenarios, but they do not specifically address the need for increased acid suppression when partial response to PPIs is observed. Instead, focusing on optimizing the current medication regimen by adjusting the dosage effectively targets the underlying mechanism of GERD and offers a straightforward step for managing symptoms.