American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is a criterion for diagnosing reflux hypersensitivity?

1. Histologic evidence of eosinophils

2. Significant motor disorder

3. Normal endoscopy findings

4. High acid exposure on pH monitoring

The correct answer is: Normal endoscopy findings

Diagnosing reflux hypersensitivity involves identifying a condition where patients experience symptoms typical of gastroesophageal reflux disease (GERD), but without the typical accompanying signs such as esophagitis or physical damage to the esophagus. This is where the presence of normal endoscopic findings becomes a key criterion. Normal endoscopy findings indicate that there are no significant mucosal injuries or visible lesions in the esophagus typically associated with GERD, such as inflammation or erosions. This absence of visible pathology is essential for establishing that the symptoms are not due to traditional reflux disease but instead may arise from hypersensitivity of the esophagus to normal acidity levels. In contrast, histologic evidence of eosinophils could suggest eosinophilic esophagitis, which is a separate condition characterized by eosinophilic infiltration rather than reflux symptoms. Significant motor disorder might point toward a different esophageal motility issue that could cause similar symptoms but is not related to reflux hypersensitivity itself. High acid exposure on pH monitoring typically indicates active gastroesophageal reflux disease, contradicting the notion of reflux hypersensitivity, where one would expect normal acid exposure levels despite having symptoms. Thus, normal endoscopy findings are crucial in diagnosing reflux hypersensitivity, as they help differentiate