Board Pearls

Board Pearls
  • 4.7 (3)
  • Medicine
  • Series

Board Pearls is a gastroenterology board review built around clinical reasoning, not recall. Each episode takes one high-yield topic and works it the way you would on rounds: a case to anchor it, the framework that sorts the differential, and the specific decisions the exam rewards. The gastroenterology series covers the full blueprint across nine modules: esophagus, stomach and duodenum, small bowel, colon, pelvic floor, liver, pancreas and biliary, endoscopy, and the cross-cutting topics. Episodes are grouped by chapter and built from the primary guidelines and pivotal trials the boards draw from (ACG, AGA, AASLD, ASGE), not from textbook summaries. Use it as an audio companion to the written curriculum, MCQs, and AI tutor at boardpearls.com. Questions or feedback: hello@boardpearls.com.

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  1. Episode 1

    Chapter 6, Ep 1 of 2: H. pylori: Biology, Eradication, and Salvage

    Every H. pylori diagnostic and every regimen is downstream of one fact: the organism survives in gastric mucus by producing urease in industrial quantities. Hold that, and the breath test, the stool antigen, the off-PPI timing rule, and the shift away from clarithromycin triple all follow.   The case. A patient treated for a duodenal ulcer returns after clarithromycin triple therapy with a positive urea breath test. Which salvage regimen do you choose, and what must you avoid repeating?   Topics covered Biology: a urease-producing spiral gram-negative living in gastric mucus Virulence: the cag pathogenicity island and vacA Urea breath test and stool antigen as active-infection tests The off-PPI rule: hold PPI 2 weeks and antibiotics/bismuth 4 weeks before testing Serology cannot distinguish active from past infection First-line has shifted: bismuth quadruple and vonoprazan-based dual/triple over clarithromycin triple Penicillin allergy and local resistance as regimen drivers Salvage: never repeat a failed macrolide or levofloxacin regimen Confirming eradication with a breath test or stool antigen after therapy Indications to test and treat: ulcer, MALT lymphoma, early gastric cancer resection, unexplained iron deficiency   Key decisions Test for active infection off acid suppression: hold the PPI 2 weeks and any antibiotics/bismuth 4 weeks, or the breath test and stool antigen turn falsely negative Clarithromycin triple is no longer first-line where resistance exceeds 15 percent: use bismuth quadruple or a vonoprazan-based regimen Salvage never reuses the antibiotic class that just failed: a failed clarithromycin regimen goes to bismuth quadruple or levofloxacin-based therapy, not another macrolide Always confirm eradication after treatment, at least 4 weeks out and off PPI, with a breath test or stool antigen, not serology Every H. pylori-positive peptic ulcer gets eradication plus confirmation, because it changes recurrence risk   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: hello@boardpearls.com. (00:00) - Opening: urease is load-bearing (02:00) - Biology and virulence factors (05:00) - Diagnostics and the off-PPI rule (09:00) - First-line: bismuth quadruple and vonoprazan regimens (13:00) - Salvage: do not repeat a failed class (16:00) - Confirming eradication and test-and-treat indications

    25 min

  2. Episode 2

    Chapter 6, Ep 2 of 2: NSAID Ulcers, Refractory Disease, and Perforation

    NSAIDs damage the gastroduodenal mucosa by two mechanisms, and the systemic COX-1 mechanism is the one that matters for prevention: no topical avoidance protects the mucosa. The risk factors are the teaching point because they do not add, they multiply, and the H. pylori interaction compounds them.   The case. A 70-year-old on daily NSAIDs and low-dose aspirin with a prior ulcer presents with a new gastric ulcer. Beyond stopping the NSAID, what does the risk-factor stack tell you about prevention going forward?   Topics covered NSAID mechanism: systemic COX-1 inhibition strips prostaglandin-driven mucosal defense Why the systemic mechanism means enteric coating does not protect Multiplicative risk factors: age over 65, prior ulcer, high-dose or multiple NSAIDs, anticoagulation, steroids The H. pylori and NSAID interaction: two pathways that compound PPI co-prescription as the primary prevention strategy in high-risk patients COX-2 selective agents: GI benefit versus cardiovascular cost Refractory ulcers: exclude persistent H. pylori, occult NSAID use, ZES, and malignancy Zollinger-Ellison: fasting gastrin, secretin stimulation, and the off-PPI caveat Gastric ulcers require follow-up to confirm healing and exclude cancer Complications: bleeding, perforation, and gastric outlet obstruction   Key decisions Every high-risk patient who must stay on an NSAID gets a co-prescribed PPI: risk factors multiply, so a stacked patient is high-risk even without a prior ulcer Enteric coating and rectal or IV routes do not protect the stomach: NSAID injury is systemic through COX-1, not topical A refractory ulcer triggers a specific checklist: confirm H. pylori eradication, hunt occult NSAID/aspirin use, check fasting gastrin for ZES, and biopsy to exclude malignancy Gastric ulcers get a follow-up endoscopy to document healing and rule out cancer; duodenal ulcers usually do not Fasting gastrin for suspected ZES must be interpreted off PPI, because acid suppression itself raises gastrin   For the full chapter with MCQs, tables, and primary-guideline references, visit www.boardpearls.com. Questions or feedback: hello@boardpearls.com. (00:00) - Opening: the systemic NSAID mechanism (02:30) - Multiplicative risk factors (05:30) - PPI co-prescription and COX-2 tradeoffs (08:30) - Refractory ulcers and the exclusion checklist (12:00) - Zollinger-Ellison and fasting gastrin (15:00) - Complications: bleeding, perforation, obstruction

    23 min
See All Season 6 (2)

Ratings & Reviews

4.7
out of 5
3 Ratings

About

Board Pearls is a gastroenterology board review built around clinical reasoning, not recall. Each episode takes one high-yield topic and works it the way you would on rounds: a case to anchor it, the framework that sorts the differential, and the specific decisions the exam rewards. The gastroenterology series covers the full blueprint across nine modules: esophagus, stomach and duodenum, small bowel, colon, pelvic floor, liver, pancreas and biliary, endoscopy, and the cross-cutting topics. Episodes are grouped by chapter and built from the primary guidelines and pivotal trials the boards draw from (ACG, AGA, AASLD, ASGE), not from textbook summaries. Use it as an audio companion to the written curriculum, MCQs, and AI tutor at boardpearls.com. Questions or feedback: hello@boardpearls.com.

Information

  • Creator
    Board Pearls
  • Episodes
    14
  • Seasons
    6
  • Rating
    Clean
  • Copyright
    © 2025
  • Show Website
    Board Pearls