Sam's Last-Minute Guide to Gastroenterology Subspecialities Board Examination

  If drugs not tolerated for primary prophylaxis of (non-bleeding) esophageal varices, consider band ligation of varices Primary prophylaxis of ESOPHAGEAL varices in medium to large varices only (not in grade 1 varices) If no large varices, then check in 1 year and then q 3 years or with change in functional status EGD for variceal screening is negative in patient with inactive disease (such as person with alcoholic cirrhosis who has stopped drinking or NASH with weight loss)- recheck q 3 years EGD variceal screening recheck q 2 years in compensated cirrhosis with ongoing liver injury EGD for variceal screening not indicated in patients with platelets > 150k and transient elastography < 20 If EGD shows no varices after variceal bleed , repeat in 3-6 months and then q 6-12 months.

  No further testing to prove GERD when patient has  Barrett’s esophagus Grade C/D esophagitis Abnormal acid exposure time off PPI > 6% with pH <4 Reflux symptom association and Mean nocturnal impedance are not diagnostic for GERD but adjunctive to acid exposure time  

Laryngopharyngeal reflux (LPR)  Treated with BID PPI x 3 months.  Positive Predictive Value of Laryngoscopy is low Impedance > Laryngoscopy or empiric PPI therapy for diagnosis of LPR (ACG 2020) Poor agreement on LPR findings  EGD findings not helpful Impedance testing off meds in LPR is to document NO GERD Ruling out GERD rules out LPR Positive GERD during Impedance testing does NOT rule in LPR Impedance testing while ON medication Previous positive study Large hiatal hernia Esophagitis on EGD

  Barrett’s with high grade dysplasia (HGD) Biopsies q 1 cm all 4 quadrant Endoscopic mucosal resection (EMR) of any nodularity Rate of progression to cancer is 6% per year  Barrett’s with low grade dysplasia (LGD) Confirm with an expert pathologist and repeat EGD with biopsy in 6 months. If still LGD then repeat EGD in 1 year PPI once a day in the absence of esophagitis Rate of progression to HGD or cancer is 0.5-13% per year Barrett’s esophagus - tongue of salmon colored mucosa noted Intestinal metaplasia of GE junction- no tongue of abnormal mucosa present Barrett’s with indefinite dysplasia, optimize therapy and repeat EGD in 3-6 months Once complete eradication of intestinal metaplasia (CEIM) is accomplished via radiofrequency ablation (RFA) therapy Repeat EGD q3 months x 1 year  Followed by q6 months for another year  Followed by q1 year from then on Patient with Barrett’s on twice daily dose proton pump inhibitors (PPI) and ongoing symptoms Check pH impedance while ON medication

While preparing for the GI boards, I have collected a knowledge bank which hopefully helps my fellow Gastroenterologists in private practice in their preparation. This may or may not be applicable to real life GI practice. With the recent changes in ABIM GI board examination, the pass rate is very high. You may not need to take time off or spend a lot of money preparing for the GI boards. However, until you get the email and the Board certification there may be some trepidation. This guide hopefully reduces your stress level for the boards. I have self-published an e-book (also available as a paperback) on Amazon Kindle titled " The Last- guide to GI board examination " for a nominal fee. I hope you find this guide useful while getting ready for the GI boards. If there are any errors or suggestions, please email me at Samslastminuteguide@gmail.com.  Good luck with the Boards!  Sam August 2022