American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary goal of performing an exercise stress test in a patient with suspected GERD?

1. To confirm the diagnosis

2. To rule out cardiac causes

3. To evaluate reflux severity

4. To assess esophageal motility

The correct answer is: To rule out cardiac causes

The primary goal of performing an exercise stress test in a patient with suspected gastroesophageal reflux disease (GERD) is to rule out cardiac causes of symptoms that may mimic those of GERD, such as chest pain or discomfort. Many patients with GERD may experience symptoms that overlap with cardiovascular issues, particularly in cases where there is atypical chest pain. An exercise stress test can help determine if these symptoms are indeed related to cardiac pathology by monitoring heart function under stress. Should any cardiac abnormalities be detected during the test, it would prompt further cardiological evaluation, separating these potentially serious conditions from GERD-related symptoms. Confirming the diagnosis of GERD typically involves history-taking, symptom assessment, and possibly endoscopy or pH monitoring, rather than an exercise stress test. Similarly, evaluating reflux severity and assessing esophageal motility are more directly investigated through other specific tests, such as esophageal manometry or 24-hour pH monitoring, rather than through exercise testing, which is not designed for these purposes. Hence, the exercise stress test serves as a critical tool in differentiating cardiac problems from gastrointestinal issues in symptomatic patients.