GERD — ESEGH MCQ

Instant feedback + full explanation. One question, done properly.

HardGERD Diagnosis and ManagementGERDESEGH

A patient with IBS-C has persistent pain despite constipation improving with a secretagogue. Low-dose amitriptyline caused intolerable constipation. Which gut-brain neuromodulator is a reasonable alternative?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Offer an SSRI with counselling

The best answer is “Offer an SSRI with counselling”. BSG allows SSRIs as second-line gut-brain neuromodulators when a TCA is ineffective or poorly tolerated, with realistic counselling about evidence. “Long-term prednisolone” is less appropriate because IBS is not treated with anti-inflammatory corticosteroids “Escalating opioid therapy” is less appropriate because opioids worsen constipation and carry dependence risk “Azathioprine” is less appropriate because there is no inflammatory target for immunosuppression “Mesalazine” is less appropriate because mesalazine is not an evidence-based IBS neuromodulator

Reference: BSG irritable bowel syndrome guideline: https://gut.bmj.com/content/70/7/1214