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Postoperative ileus — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Postoperative ileusUSMLE Step 3

A patient completes 14 days of bismuth quadruple therapy for H. pylori and feels well. She takes omeprazole daily and asks how eradication should be confirmed. Which plan is appropriate?

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Correct answer: D — Withhold omeprazole 2 weeks; at least 4 weeks after antibiotics, use urea breath testing or fecal antigen testing

The best answer is “Withhold omeprazole 2 weeks; at least 4 weeks after antibiotics, use urea breath testing or fecal antigen testing”. Symptom resolution does not prove cure, and serology can remain positive after eradication. Delaying testing beyond the antibiotic effect and withholding acid suppression reduce false-negative urea breath and fecal antigen results; H2-receptor antagonists or antacids can bridge the PPI-free interval. All treated patients need proof of H. pylori eradication with a urea breath test, fecal antigen test, or biopsy-based test at least 4 weeks after antibiotics and after withholding proton-pump inhibitors or PCABs for at least 2 weeks. The alternatives use a different threshold, timing, population, or intervention and therefore do not match the clinical facts presented.

Reference: American College of Gastroenterology: 2024 H. pylori Guideline Summary: https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/