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Exam 1: Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors
GASTROENTEROLOGY 2012;142:e14 – e16
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for specific learning objective.
Exam 1: Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors Contact hours: 1.0 Expiration Date: June 30, 2013 Test ID No.: gastro00162
Question 1: A 36-year-old man previously diagnosed with eosinophilic esophagitis (EoE) presents to the clinic with worsening symptoms of dysphagia and food impaction. Endoscopy performed after 8 weeks of proton pump inhibitor therapy reveals rings, longitudinal furrows, and exudates in the esophagus and biopsies reveal ⬎50 eos/hpf. The patient is reluctant to use topical corticosteroids and is interested in dietary therapy. Based on the study by Gonsalves et al, a diet eliminating which of the following ingredients has been shown to be effective in treating EoE in adults?
a. b. c. d. e.
Milk, soy, beef, chicken, seafood, and beans. Milk, soy, egg, rice, corn, and seafood. Milk, soy, egg, wheat, nuts, and seafood. Wheat, nuts, seafood, corn, apples, and rice. Wheat, nuts, beef, chicken, apples, and beans.
a. b. c. d. e.
90%. 70%. 50%. 30%. 10%.
a. b. c. d. e.
Milk and soy. Seafood and nuts. Soy and egg. Wheat and soy. Milk and wheat.
Question 2: Based on the study by Gonsalves et al, what percentage of adult patients achieved histologic remission of ⱕ10 eos/hpf after 6 weeks of dietary therapy with a 6-food elimination diet?
Question 3: Based on the study, which 2 foods were found to be the most common food triggers causing EoE in adults?
June 2012
CME ACTIVITIES
e15
Question 4: Which of the following features were shown to improve after the 6-food elimination diet in adult EoE?
a. b. c. d. e.
Symptoms. Histology. Endoscopic changes. Quality of life. All of the above.
Question 5: Current practical limitations of the 6-food elimination diet in the treatment of adults with EoE include all of the following except:
a. Need for repeated endoscopies with biopsies to identify trigger foods during the reintroduction process. b. Substantial dietary and lifestyle modification is required to adhere to the elimination diet. c. The high accuracy of skin prick testing for food allergens obviates the need for the empiric elimination of foods. d. Necessity for expert dietary consultation to avoid unintentional contamination of the elimination diet. e. Absence of data on the long-term durability of response to food elimination in the treatment of EoE in adults.
Exam 2: Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis Contact hours: 1.0 Expiration Date: June 30, 2013 Test ID No.: gastro00163
Question 1: The following risk factors are associated with a significantly increased risk for the development of severe acute pancreatitis, except:
a. b. c. d. e.
Older age. Alcohol use. Diabetes. Obesity. Monocyte chemotactic protein-1 (MCP-1) ⫺2351 G allele.
a. b. c. d. e.
1 2 3 4 5
a. b. c. d. e.
Ranson. SIRS. BISAP. BUN. None.
Question 2: A 65-year-old man presents to the emergency room with complaints of severe epigastric pain for 8 hours associated with nausea and vomiting. His temperature was 39.2°C, heart rate of 112 bpm, blood pressure of 130/80 mmHg, and respiratory rate of 16/min. Laboratory work showed a WBC count of 22,000/mL, hematocrit of 49%, blood urea nitrogen (BUN) of 30 mg/dL, and glucose of 230 mg/dL. What are the calculated systemic inflammatory response syndrome (SIRS) and Glasgow scores for this patient based on the available data?
and and and and and
1. 2. 3. 4. 5.
Question 3: Which of the following admission clinical scores or laboratory values has shown the highest accuracy in predicting persistent organ failure in patients with acute pancreatitis?
CONTINUING MEDICAL EDUCATION (CME) ACTIVITIES CME Credits: The American Gastroenterological Association Institute (AGA Institute) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGA Institute designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGA Institute implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.
Instructions: Category 1 credit can be earned by reading the relevant article and taking these CME examinations online at http://www.gastrojournal.org/content/cme. Answers to the questions are provided after taking the exams.
Objectives: See article for specific learning objective.
Exam 1: Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors Contact hours: 1.0 Expiration Date: June 30, 2013 Test ID No.: gastro00162
Question 1: A 36-year-old man previously diagnosed with eosinophilic esophagitis (EoE) presents to the clinic with worsening symptoms of dysphagia and food impaction. Endoscopy performed after 8 weeks of proton pump inhibitor therapy reveals rings, longitudinal furrows, and exudates in the esophagus and biopsies reveal ⬎50 eos/hpf. The patient is reluctant to use topical corticosteroids and is interested in dietary therapy. Based on the study by Gonsalves et al, a diet eliminating which of the following ingredients has been shown to be effective in treating EoE in adults?
a. b. c. d. e.
Milk, soy, beef, chicken, seafood, and beans. Milk, soy, egg, rice, corn, and seafood. Milk, soy, egg, wheat, nuts, and seafood. Wheat, nuts, seafood, corn, apples, and rice. Wheat, nuts, beef, chicken, apples, and beans.
a. b. c. d. e.
90%. 70%. 50%. 30%. 10%.
a. b. c. d. e.
Milk and soy. Seafood and nuts. Soy and egg. Wheat and soy. Milk and wheat.
Question 2: Based on the study by Gonsalves et al, what percentage of adult patients achieved histologic remission of ⱕ10 eos/hpf after 6 weeks of dietary therapy with a 6-food elimination diet?
Question 3: Based on the study, which 2 foods were found to be the most common food triggers causing EoE in adults?
June 2012
CME ACTIVITIES
e15
Question 4: Which of the following features were shown to improve after the 6-food elimination diet in adult EoE?
a. b. c. d. e.
Symptoms. Histology. Endoscopic changes. Quality of life. All of the above.
Question 5: Current practical limitations of the 6-food elimination diet in the treatment of adults with EoE include all of the following except:
a. Need for repeated endoscopies with biopsies to identify trigger foods during the reintroduction process. b. Substantial dietary and lifestyle modification is required to adhere to the elimination diet. c. The high accuracy of skin prick testing for food allergens obviates the need for the empiric elimination of foods. d. Necessity for expert dietary consultation to avoid unintentional contamination of the elimination diet. e. Absence of data on the long-term durability of response to food elimination in the treatment of EoE in adults.
Exam 2: Comparison of Existing Clinical Scoring Systems to Predict Persistent Organ Failure in Patients With Acute Pancreatitis Contact hours: 1.0 Expiration Date: June 30, 2013 Test ID No.: gastro00163
Question 1: The following risk factors are associated with a significantly increased risk for the development of severe acute pancreatitis, except:
a. b. c. d. e.
Older age. Alcohol use. Diabetes. Obesity. Monocyte chemotactic protein-1 (MCP-1) ⫺2351 G allele.
a. b. c. d. e.
1 2 3 4 5
a. b. c. d. e.
Ranson. SIRS. BISAP. BUN. None.
Question 2: A 65-year-old man presents to the emergency room with complaints of severe epigastric pain for 8 hours associated with nausea and vomiting. His temperature was 39.2°C, heart rate of 112 bpm, blood pressure of 130/80 mmHg, and respiratory rate of 16/min. Laboratory work showed a WBC count of 22,000/mL, hematocrit of 49%, blood urea nitrogen (BUN) of 30 mg/dL, and glucose of 230 mg/dL. What are the calculated systemic inflammatory response syndrome (SIRS) and Glasgow scores for this patient based on the available data?
and and and and and
1. 2. 3. 4. 5.
Question 3: Which of the following admission clinical scores or laboratory values has shown the highest accuracy in predicting persistent organ failure in patients with acute pancreatitis?