American Board of Internal Medicine (ABIM) Certification Practice Exam

Which therapies are recommended for managing systemic sclerosis-associated esophagitis and gastritis?

1. H2 blockers and proton pump inhibitors

2. Surgical intervention

3. Antacids only

4. Antibiotic therapy

The correct answer is: H2 blockers and proton pump inhibitors

The management of systemic sclerosis-associated esophagitis and gastritis often involves the use of H2 blockers and proton pump inhibitors. These medications are effective in reducing gastric acidity and addressing symptoms such as gastroesophageal reflux disease (GERD), which is commonly encountered in patients with systemic sclerosis due to the involvement of esophageal motility and structural changes. H2 blockers work by blocking histamine receptors in gastric cells, decreasing stomach acid production, while proton pump inhibitors (PPIs) inhibit the hydrogen-potassium ATPase in the gastric parietal cells, leading to a significant reduction in gastric acid secretion. Systemic sclerosis can lead to esophageal dysfunction, resulting in decreased peristalsis and esophageal reflux, which H2 blockers and PPIs can help alleviate. Additionally, managing gastric acidity can reduce the risk of esophagitis and gastritis complications, such as strictures and ulcers. Surgical intervention is generally not the first-line treatment for esophagitis and gastritis associated with systemic sclerosis unless there are severe complications that do not respond to medical management. Antacids may provide temporary relief by neutralizing gastric acid but do not address the underlying issues of esophageal motility and its chronic symptoms. Antibiotic therapy is not indicated