American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the suggested approach for dyspepsia in patients younger than 50 years without alarm features?

1. Immediate endoscopy

2. Test-and-treat approach for Helicobacter pylori

3. Long-term proton pump inhibitor therapy

4. Refer to a gastroenterologist

The correct answer is: Test-and-treat approach for Helicobacter pylori

The suggested approach for dyspepsia in patients younger than 50 years without alarm features is the test-and-treat strategy for Helicobacter pylori. This recommendation stems from the understanding that many individuals in this demographic may experience dyspepsia due to H. pylori infection, a common bacterial cause of gastrointestinal discomfort that can lead to peptic ulcers and gastritis. By employing a test-and-treat strategy, healthcare providers first screen for H. pylori and, if positive, initiate eradication therapy. This approach has the potential to relieve symptoms effectively without the need for invasive procedures such as endoscopy, which is not typically warranted in younger patients without concerning symptoms (i.e., alarm features such as significant weight loss, vomiting, or blood in stool). A test-and-treat strategy is evidence-based, with studies demonstrating that treating H. pylori not only alleviates dyspepsia but may also prevent future complications associated with untreated infections. Long-term proton pump inhibitor therapy might provide symptom relief but does not address the underlying cause of dyspepsia and can lead to unnecessary medication use and potential side effects. Immediate endoscopy is generally reserved for patients who present with alarm features, and referring to a gastroenterologist may