American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be done if either the endoscopic test or fecal antigen test is positive in a patient with bleeding PUD?

1. Perform a biopsy

2. Pursue treatment for H. pylori

3. Schedule for surgery

4. Observe the patient

The correct answer is: Pursue treatment for H. pylori

When either the endoscopic test or fecal antigen test is positive in a patient with bleeding peptic ulcer disease (PUD), pursuing treatment for Helicobacter pylori (H. pylori) is a crucial step. H. pylori is a common causative factor in the development of peptic ulcers, and its eradication is essential not only to promote healing of the ulcer but also to reduce the risk of future ulcer recurrence. The presence of H. pylori infection contributes to the pathogenesis of ulcers, and treating it can significantly improve outcomes for patients, especially those with complications such as bleeding. Once H. pylori is confirmed through appropriate testing, initiating appropriate antibiotic therapy along with acid suppression is generally indicated to address both the infection and the ulcer itself. Focusing on treatment rather than a biopsy, surgical intervention, or mere observation is vital in this context as the objective is to identify and eliminate the underlying cause of the bleeding, which is effectively achieved through H. pylori eradication therapy. Other approaches like biopsy may be reserved for cases where malignancy is suspected or when an ulcer's characteristics warrant further investigation, but they do not directly address the current need for intervention following a positive test for H. pylori.