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GERD PPI timing — USMLE Step 3 MCQ

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ModerateAmbulatory Medicine / Primary CareGERD PPI timingUSMLE Step 3

A 48-year-old man with chronic GERD has persistent heartburn despite once-daily omeprazole. He takes it with dinner. He has no dysphagia, weight loss, bleeding, or anemia. Which of the following is the most appropriate next step in management?

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

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Correct answer: B — Optimize proton pump inhibitor timing before breakfast

PPIs should be taken 30-60 minutes before a meal, typically breakfast. In the absence of alarm features, optimizing administration is appropriate before invasive testing.

Reference: American College of Gastroenterology GERD Guideline