ROSH Gastrointestinal Practice Exam

What condition should be ruled out as a contraindication to surgical intervention in patients with recurrent heartburn?

1. Benign esophageal strictures

2. Gastroparesis

3. Hiatal hernia

4. Scleroderma

The correct answer is: Gastroparesis

Gastroparesis should be ruled out as a contraindication to surgical intervention in patients experiencing recurrent heartburn because this condition significantly affects gastric motility and the movement of food through the digestive tract. In patients with gastroparesis, the stomach empties more slowly than normal, which can lead to symptoms such as nausea, bloating, abdominal pain, and, importantly, can influence the effectiveness of interventions aimed at reducing acid reflux or heartburn. Surgical options for treating conditions related to reflux, such as fundoplication, would not only take into consideration the nature of the reflux but also the underlying motility of the gastrointestinal tract. If a patient has gastroparesis, the surgical corrections may lead to complications, such as postoperative ileus or worsening of symptoms, as the normal anatomical function might be impaired, rendering the surgery less effective or even harmful. The other conditions—benign esophageal strictures, hiatal hernia, and scleroderma—while they may be associated with reflux symptoms, do not inherently contraindicate surgical intervention in the same way that gastroparesis does. For instance, surgical intervention can often address structural issues like strictures and hernias, and proper management strategies are identified for patients with scler