ANSWERS // From page 12
Q1: Answer: B
Objective: Recognize the features of CVID associated noninfectious gastrointestinal manifestations
Explanation: This patient has gastrointestinal manifestations
of common variable immune deficiency (CVID), which can
present similarly to celiac disease or inflammatory bowel
disease. Histologically, intestinal biopsies will reveal villous
atrophy, crypt hyperplasia, and intraepithelial lymphocytosis similar to celiac disease. However, while plasma cells are
increased in celiac disease, they are absent in common variable immune deficiency.
The initial treatment strategy for CVID typically includes
oral corticosteroids, either prednisone or budesonide, with
other immunosuppressants such as the thiopurines or anti-tumor necrosis factor agents reserved for steroid-dependent
or refractory disease.
Gluten-free diet is ineffective for the treatment of CVID-as-sociated enteropathy. Intravenous immunoglobulin therapy
reduces the frequency of infections associated with CVID,
but does not affect the noninfectious GI symptoms. While
bacterial overgrowth can occur in CVID, it is typically the
consequence of the luminal changes, not the cause.
1. Agarwal S., Mayer L. Gastrointestinal manifestations in primary immune
disorders. Inflamm Bowel Dis. 2010;16:703-11.
Q2: Answer: D
Current recommendation suggests H. pylori testing for pa-
tients with active or a documented history of peptic ulcer
disease, gastric MALT lymphoma, or gastric carcinoma. The
H. pylori test-and-treat strategy is also recommended for pa-
tients less than 55 years of age who presents with dyspepsia
symptoms without “alarm features.”
There is currently no recommendation for asymptomatic
family members of patients diagnosed with H. pylori infec-
tion to be tested, unless there are known factors that may
increase the patient’s risk for gastric malignancy (e.g., family
history of gastric carcinoma, and ethnic background from ar-
eas with high prevalence of H. pylori and gastric cancer such
as East Asia, Latin America, and Eastern Europe).
1. Chey W.D., Wong BC; Practice Parameters Committee of the American
College of Gastroenterology. American College of Gastroenterology guideline
on the management of Helicobacter pylori infection. Am J Gastroenterol.
2. Talley N.J., Vakil N.B., Moayyedi P. American Gastroenterological Association technical review on the evaluation of dyspepsia. Gastroenterology
3. Suerbaum S. Michetti P. Helicobacter pylori infection. N Engl J Med.
4. Everhart J.E., Kruszon-Moran D., Perez-Perez G.I., et al. Seroprevalence and
ethnic differences in Helicobacter pylori infection among adults in the United
States. J Infect Dis. 2000;181:1359-63.