American Board of Internal Medicine Certification (ABIM Board Certification) Gastroenterology & Hepatology Syllabus

Gastroenterology & Hepatology syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Gastroenterology & Hepatology in American Board of Internal Medicine Certification (ABIM Board Certification), not a summary of it.

1. 1

   Esophageal & Gastric Disorders

   4 topics

   • GERD and Barrett's esophagus surveillance
   • Dysphagia and motility disorders
   • Peptic ulcer disease and H. pylori
   • Upper GI bleeding management
2. 2

   Intestinal & Colonic Disorders

   5 topics

   • Inflammatory bowel disease
     • Crohn's vs ulcerative colitis
     • Biologic and immunomodulator therapy
   • Irritable bowel syndrome
   • Celiac disease and malabsorption
   • Colorectal cancer screening and polyp surveillance
   • Lower GI bleeding and diverticular disease
3. 3

   Pancreaticobiliary Disease

   3 topics

   • Acute and chronic pancreatitis
   • Cholelithiasis and biliary tract disease
   • Pancreatic cancer evaluation
4. 4

   Liver Disease

   5 topics

   • Viral hepatitis (A through E)
     • Hepatitis B and C treatment and screening
   • Cirrhosis and portal hypertension complications
     • Ascites, SBP, hepatic encephalopathy
     • Variceal bleeding prophylaxis
   • Metabolic dysfunction-associated steatotic liver disease (MASLD)
   • Autoimmune and cholestatic liver disease
   • Acute liver failure and abnormal liver chemistries

Gastroenterology & Hepatology flashcards for American Board of Internal Medicine Certification (ABIM Board Certification)

24 of 52 cards from the Gastroenterology & Hepatology deck — real questions with worked answers.

1. What endoscopic surveillance interval is recommended for Barrett's esophagus with NO dysplasia?

   Every 3-5 years with high-resolution endoscopy and Seattle protocol (4-quadrant biopsies every 2 cm).

2. What is the management of Barrett's esophagus with confirmed high-grade dysplasia?

   Endoscopic eradication therapy - endoscopic resection of visible lesions plus radiofrequency ablation of remaining Barrett's segment.

3. What alarm features in GERD warrant prompt upper endoscopy?

   Dysphagia, odynophagia, weight loss, GI bleeding/anemia, recurrent vomiting, and onset of new symptoms age >60.

4. How do you distinguish oropharyngeal from esophageal dysphagia clinically?

   Oropharyngeal: trouble initiating swallow, coughing/choking/nasal regurgitation (transfer problem). Esophageal: food sticking seconds after swallowing in the chest.

5. What manometric findings define achalasia?

   Incomplete LES relaxation (elevated integrated relaxation pressure) plus absent (100%) peristalsis in the esophageal body.

6. What is the classic barium swallow finding in achalasia?

   "Bird's beak" - dilated esophagus tapering to a narrow gastroesophageal junction.

7. How do you differentiate dysphagia to solids only versus solids and liquids?

   Solids only suggests a mechanical/structural obstruction (stricture, ring, cancer); solids AND liquids from onset suggests a motility disorder.

8. What are the two main causes of peptic ulcer disease?

   Helicobacter pylori infection and NSAID use.

9. What is first-line therapy for H. pylori in areas of high clarithromycin resistance or prior macrolide exposure?

   Bismuth quadruple therapy: PPI + bismuth + tetracycline + metronidazole for 14 days.

10. How should H. pylori eradication be confirmed, and what must precede the test?

    Urea breath test or stool antigen test at least 4 weeks after antibiotics; hold PPI for 1-2 weeks to avoid false negatives.

11. Which type of peptic ulcer typically improves with eating, gastric or duodenal?

    Duodenal ulcer pain improves with food; gastric ulcer pain often worsens with eating.

12. What is the initial pharmacologic management of acute upper GI bleeding from a suspected variceal source?

    IV octreotide (vasoactive) plus IV antibiotics (e.g., ceftriaxone) for prophylaxis, in addition to resuscitation.

13. In nonvariceal upper GI bleeding, what is the role of PPI therapy and timing of endoscopy?

    IV PPI to stabilize clot; upper endoscopy within 24 hours for diagnosis and hemostasis.

14. What hemoglobin transfusion threshold is recommended in stable upper GI bleeding?

    Restrictive strategy - transfuse for hemoglobin <7 g/dL (target 7-9), unless active cardiovascular disease.

15. What endoscopic stigmata of an ulcer carry the HIGHEST rebleeding risk (Forrest classification)?

    Active spurting/oozing bleeding (Forrest Ia/Ib) and a non-bleeding visible vessel (Forrest IIa).

16. What distinguishes Crohn's disease from ulcerative colitis in terms of distribution?

    Crohn's: any part of GI tract, skip lesions, transmural inflammation. UC: continuous involvement starting at rectum, limited to colon, mucosal/submucosal only.

17. Which IBD is associated with fistulas, strictures, and granulomas on histology?

    Crohn's disease (transmural inflammation with non-caseating granulomas).

18. What antibody pattern helps distinguish UC from Crohn's disease?

    p-ANCA positive favors UC; ASCA (anti-Saccharomyces cerevisiae) positive favors Crohn's disease.

19. What is the increased cancer surveillance recommendation in long-standing colonic IBD?

    Begin surveillance colonoscopy 8 years after diagnosis of colitis, then every 1-3 years with biopsies for dysplasia.

20. What are the Rome IV diagnostic criteria for irritable bowel syndrome?

    Recurrent abdominal pain >=1 day/week in last 3 months, associated with >=2 of: relation to defecation, change in stool frequency, change in stool form.

21. What serologic test is the best initial screen for celiac disease, and what must the patient be doing?

    Tissue transglutaminase IgA (tTG-IgA) with total IgA level; the patient must be on a gluten-containing diet.

22. What is the gold-standard confirmatory test and classic histology for celiac disease?

    Duodenal biopsy showing villous atrophy, crypt hyperplasia, and intraepithelial lymphocytosis.

23. Which HLA haplotypes are associated with celiac disease (and useful for ruling it out)?

    HLA-DQ2 and HLA-DQ8; their absence has a high negative predictive value.

24. What skin condition is pathognomonic for celiac disease?

    Dermatitis herpetiformis - pruritic vesicular rash on extensor surfaces, treated with dapsone and gluten-free diet.

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