An Evidence-Based Approach to
Please mark the letter of the best answer to each 6. Which of the following is true about lifestyle modifica-
tions for FHB?
question on the answer sheet. A score of 80% or a. As a solo intervention, they have been proven to
higher is necessary to pass the test. lessen symptomatology.
b. They are more effective than antacids or acid
suppressants in relieving heartburn.
1. Frequent heartburn (FHB) is distinguished from c. They are likely to enhance the efficacy of FHB
episodic heartburn by the fact that it: medication.
a. occurs at least once a month. d. They include measures such as aerobic exercise
b. occurs at least twice per week. and weight-lifting.
c. causes injury to the esophagus.
7. True or false: Antacids more suitable for patients with
d. is unrelated to the type of food eaten.
episodic heartburn than for those with FHB.
2. Approximately what proportion of US adults
8. Which is the only over-the-counter (OTC) medication
experience heartburn at least once per week?
specifically indicated for FHB?
a. omeprazole magnesium
b. ranitidine hydrochloride
c. magnesium hydroxide
d. rabeprazole sodium
3. Which of the following activities is the least likely
9. According to a summary of findings to date in patients
to cause FHB?
with symptomatic gastroesophageal reflux disease,
a. taking a leisurely walk after dinner
which pharmacologic approach is judged to be the most
b. eating a fried, fatty meal
c. lying down shortly after dining
a. combination therapy with OTC antacids and
d. drinking several cups of coffee per day
histamine H2-receptor antagonists (H2RAs)
4. Which of the following statements is false? b. proton pump inhibitor-based step-down or
a. More than 50% of heartburn sufferers have on-demand therapy
endoscopically normal esophageal mucosa. c. lifestyle modifications plus antacids
b. All gastroesophageal reflux is pathologic. d. prescription-strength H2RAs or prokinetics
c. Many patients with heartburn symptoms have
10. A surgical consult is specifically recommended for
normal amounts of esophageal acid exposure.
d. Many patients with excessive esophageal acid
a. “alarm” symptoms such as anemia, bleeding,
exposure do not have mucosal injury.
dysphagia, involuntary weight loss, odynophagia,
5. Diagnostic testing is recommended in patients with or persistent vomiting.
FHB who: b. an uncertain diagnosis.
a. have been experiencing symptoms for 7 to 10 years. c. documented GERD symptoms that are responsive to
b. are experiencing pulmonary symptoms such as chron- medical therapy but who do not wish to continue
ic cough or bronchitis. long-term medical therapy.
c. complain of difficulty swallowing. d. extra-esophageal symptoms such as asthma,
d. all of the above. non-cardiac chest pain, or pharyngitis.