American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary treatment for gastroesophageal reflux disease in patients without alarm features?

1. Antibiotics

2. H2 receptor antagonists

3. Proton pump inhibitors

4. Antacids

The correct answer is: Proton pump inhibitors

The primary treatment for gastroesophageal reflux disease (GERD) in patients without alarm features is proton pump inhibitors (PPIs). PPIs work by irreversibly blocking the proton pump in the stomach lining, significantly reducing gastric acid production. This helps alleviate symptoms of GERD such as heartburn and regurgitation, and it also promotes healing of any esophageal mucosal damage caused by acid exposure. In the context of treating GERD, it's important to recognize that while antacids and H2 receptor antagonists can provide symptomatic relief, they are not as effective as PPIs for long-term management and healing of esophagitis. Antacids may neutralize existing stomach acid quickly but do not provide a prolonged effect. H2 receptor antagonists do decrease acid secretion but typically do not offer the same level of acid suppression compared to PPIs, making them less effective for moderate to severe cases of GERD. Antibiotics are not a treatment for GERD, as they target bacterial infections rather than the acid production or esophageal irritation associated with this condition. Thus, the use of PPIs is the recommended approach for managing GERD in patients without alarm features, focusing on both symptom relief and prevention of complications related to chronic acid exposure