100+ Free ABIM GI Practice Questions

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Question 1

Score: 0/0

A 48-year-old with chronic GERD undergoes upper endoscopy. Biopsy shows salmon-colored mucosa extending 4 cm above the GE junction with specialized intestinal metaplasia and no dysplasia. What is the appropriate surveillance interval per current ACG guidelines for Barrett esophagus without dysplasia?

Endoscopy every 3-5 years

Endoscopy every 6 months

Endoscopy annually

No further surveillance is indicated

to track

2026 Statistics

Key Facts: ABIM GI Exam

~$2,990

ABIM GI Exam Fee

ABIM 2026

~220 MCQs

Exam Length

4 modules, ~10 hr day

3 years

GI Fellowship

ACGME-accredited

Age 45

CRC Screening Start

USPSTF 2021

85-92%

First-Time Pass Rate

ABIM historical

March 2024

Resmetirom for MASH F2-F3

FDA approval

The ABIM Gastroenterology boards integrate rapidly evolving hepatology (pangenotypic HCV DAAs, MASLD/MASH renaming in 2023 with resmetirom FDA approval March 2024, and new PBC second-line agents elafibranor and seladelpar approved 2024), IBD therapeutics (risankizumab 2022 and mirikizumab/guselkumab UC/Crohn 2024, ozanimod/etrasimod S1P modulators, JAK inhibitors with black-box warnings, TDM), advanced endoscopy (POEM for achalasia, EMR/ESD, pancreatic cyst risk stratification Fukuoka/Kyoto), and updated ACG guidelines including 2024 H. pylori favoring bismuth quadruple therapy because of US clarithromycin resistance >15%. Certified gastroenterologists earn a median $500K-$550K (MGMA) and command premium in endoscopy-heavy practices with >150,000 GI fellowship graduates over ABIM history — making GI one of the highest-compensated IM subspecialties.

Sample ABIM GI Practice Questions

Try these sample questions to test your ABIM GI exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 48-year-old with chronic GERD undergoes upper endoscopy. Biopsy shows salmon-colored mucosa extending 4 cm above the GE junction with specialized intestinal metaplasia and no dysplasia. What is the appropriate surveillance interval per current ACG guidelines for Barrett esophagus without dysplasia?

A.Endoscopy every 3-5 years

B.Endoscopy every 6 months

C.Endoscopy annually

D.No further surveillance is indicated

Explanation: Per ACG 2022/2023 guidelines, surveillance endoscopy for nondysplastic Barrett esophagus with segments 3 cm or longer is recommended every 3-5 years using the Seattle biopsy protocol (4-quadrant biopsies every 2 cm). Barrett esophagus confers a ~0.1-0.3% per year risk of progression to esophageal adenocarcinoma. Shorter intervals (6-12 months) apply to low-grade or indefinite dysplasia; high-grade dysplasia and intramucosal cancer should undergo endoscopic eradication therapy.

2Which Los Angeles classification grade of erosive esophagitis describes one or more mucosal breaks longer than 5 mm that do NOT extend between the tops of two mucosal folds?

A.LA Grade B

B.LA Grade A

C.LA Grade C

D.LA Grade D

Explanation: The Los Angeles classification for erosive esophagitis: Grade A = mucosal break <=5 mm; Grade B = break >5 mm not extending between folds; Grade C = breaks extending between tops of two or more folds but involving <75% of circumference; Grade D = breaks involving >=75% of circumference. LA C and D are considered severe and are associated with higher complication rates and need for long-term PPI therapy.

3A 52-year-old presents with progressive dysphagia to solids and liquids and regurgitation of undigested food. High-resolution manometry shows 100% failed peristalsis, a median integrated relaxation pressure of 25 mmHg, and panesophageal pressurizations. Which Chicago Classification v4.0 achalasia subtype best fits?

A.Type II achalasia

B.Type I achalasia

C.Type III (spastic) achalasia

D.EGJ outflow obstruction

Explanation: Chicago Classification v4.0 achalasia subtypes: Type I = failed peristalsis with no pressurization; Type II = failed peristalsis with panesophageal pressurization in >=20% of swallows; Type III = spastic contractions (distal latency <4.5 s) in >=20% of swallows. Type II has the best response to treatment (pneumatic dilation, Heller myotomy, or POEM). Type III often requires POEM given the longer myotomy needed to address spastic segments.

4A 35-year-old with dysphagia and food impaction has endoscopic biopsies showing 25 eosinophils per high-power field in the distal and proximal esophagus. Which FDA-approved biologic was approved in 2022 as the first targeted therapy for eosinophilic esophagitis (EoE)?

A.Dupilumab

B.Omalizumab

C.Mepolizumab

D.Benralizumab

Explanation: Dupilumab (anti-IL-4Ralpha, blocks IL-4 and IL-13 signaling) was FDA-approved in May 2022 for adults and adolescents with EoE (>=12 years, >=40 kg) and extended to children >=1 year in 2024 — the first targeted biologic for EoE. Other first-line options include high-dose PPI, swallowed topical corticosteroids (budesonide oral suspension, fluticasone), and dietary elimination. Histologic diagnosis requires >=15 eos/HPF in the absence of alternative causes.

5Per the 2024 ACG guideline, what is the preferred first-line empiric regimen for Helicobacter pylori infection in the United States given high clarithromycin resistance?

A.Bismuth quadruple therapy (PPI + bismuth + tetracycline + metronidazole) for 10-14 days

B.Clarithromycin triple therapy (PPI + clarithromycin + amoxicillin) for 7 days

C.Levofloxacin triple therapy for 7 days

D.Rifabutin triple therapy for 14 days

Explanation: The 2024 ACG H. pylori guideline recommends bismuth quadruple therapy (PPI + bismuth subsalicylate/subcitrate + tetracycline + metronidazole) for 10-14 days as preferred empiric first-line therapy in the United States because of clarithromycin resistance rates now exceeding 15% in most regions. Rifabutin triple therapy (Talicia) is an alternative. Clarithromycin-based regimens should only be used when susceptibility is confirmed or local resistance is known to be <15%. Resistance-guided therapy is encouraged when testing is available.

6A 60-year-old presents with hematemesis and melena. EGD shows a duodenal ulcer with a visible non-bleeding vessel. Per the Forrest classification, what is the appropriate management?

A.Endoscopic hemostasis with dual therapy plus IV PPI bolus and continuous infusion

B.Observation only, oral PPI alone

C.Urgent surgical exploration

D.Tranexamic acid infusion without endoscopic therapy

Explanation: Forrest IIa (non-bleeding visible vessel) has a 50% rebleeding risk without intervention. Management includes endoscopic hemostasis — combination therapy (injection of dilute epinephrine PLUS a second modality such as bipolar coagulation, hemoclips, or hemospray) — followed by IV PPI bolus (80 mg) + continuous infusion (8 mg/h) for 72 hours. Oral PPI is acceptable for Forrest IIc (flat pigmented spot) and III (clean base). Forrest Ia (spurting) and Ib (oozing) have the highest rebleeding risk.

7A 45-year-old has recurrent peptic ulcers despite H. pylori eradication and PPI therapy, with diarrhea and a fasting serum gastrin of 1,600 pg/mL (normal <100). Which diagnosis is most likely?

A.Zollinger-Ellison syndrome (gastrinoma)

B.Pernicious anemia

C.Atrophic gastritis

D.Chronic PPI use alone

Explanation: A fasting gastrin >1,000 pg/mL with gastric pH <2 strongly suggests Zollinger-Ellison syndrome (gastrinoma). PPI use, atrophic gastritis, and pernicious anemia can raise gastrin but typically with hypochlorhydria (high pH). Confirm with secretin stimulation test (paradoxical rise in gastrin) and localize with somatostatin receptor imaging (gallium-68 DOTATATE PET/CT). ~25% are associated with MEN1 — screen for parathyroid and pituitary involvement.

8Which is the recommended first-line serologic test for celiac disease in a symptomatic adult on a gluten-containing diet?

A.Tissue transglutaminase IgA antibody (tTG-IgA) with total IgA level

B.Antigliadin IgG antibody alone

C.HLA-DQ2/DQ8 typing

D.Stool fat quantification

Explanation: ACG and AGA guidelines recommend tTG-IgA as the first-line serologic test for celiac disease, always with a total IgA level to detect selective IgA deficiency (2-3% of celiac patients). If IgA deficient, use IgG-based tests (deamidated gliadin peptide IgG or tTG-IgG). Duodenal biopsy showing villous atrophy (Marsh 3) remains the confirmatory test in adults. HLA-DQ2/DQ8 is useful only for its high negative predictive value. The patient must be on a gluten-containing diet for valid testing.

9A patient with short bowel syndrome after extensive small bowel resection has chronic parenteral nutrition dependence. Which GLP-2 analog reduces PN requirements by enhancing intestinal adaptation?

A.Teduglutide

B.Octreotide

C.Linaclotide

D.Semaglutide

Explanation: Teduglutide is a recombinant GLP-2 analog that increases villous height and crypt depth, enhancing absorption in short bowel syndrome. In trials (STEPS), it reduced PN/IV fluid requirements by >=20% in a majority of treated patients. Side effects include abdominal pain, polyp growth (colonoscopy surveillance required), pancreatitis, and stoma-related complications. Octreotide reduces high-output stoma but does not improve absorption. Linaclotide is used for IBS-C/CIC; semaglutide is a GLP-1 agonist for diabetes/obesity.

10A 30-year-old presents with bloating, abdominal pain, and diarrhea. Hydrogen-methane breath test after lactulose shows a rise of 25 ppm in hydrogen within 90 minutes. What is the most likely diagnosis?

A.Small intestinal bacterial overgrowth (SIBO)

B.Lactose intolerance

C.Celiac disease

D.Chronic mesenteric ischemia

Explanation: A rise of >=20 ppm in hydrogen within 90 minutes after lactulose (or glucose) challenge supports SIBO. Treatment options include rifaximin 550 mg TID x 14 days, sometimes combined with neomycin for methanogenic overgrowth (now termed IMO — intestinal methanogen overgrowth). Recurrence is common; address underlying risk factors (strictures, motility disorders, achlorhydria, anatomic blind loops). Lactose intolerance breath testing uses lactose as the substrate and a rise >20 ppm is diagnostic.

About the ABIM GI Exam

The ABIM Gastroenterology subspecialty exam certifies internists who have completed a 3-year ACGME-accredited GI fellowship. It covers the full breadth of gastrointestinal and liver disease: esophageal disorders including GERD, Barrett esophagus, achalasia, and eosinophilic esophagitis; stomach and small bowel disease including peptic ulcer, H. pylori, celiac disease, and SIBO; inflammatory bowel disease and biologic therapy; colon and anorectal disease including CRC screening, Lynch syndrome, and C. difficile; pancreatic disease including acute and chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer; hepatology including viral hepatitis, MASLD/MASH, cirrhosis, AIH, PBC, PSC, hemochromatosis, and liver transplantation; biliary disease; functional GI disease; GI bleeding; nutrition; and endoscopic principles.

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail; specific cut not published)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM GI Exam Content Outline

22%

Esophagus, Stomach, and Small Intestine

GERD and Los Angeles grading (A-D), Barrett surveillance q3-5 years, Chicago Classification v4.0 achalasia (types I/II/III; Heller vs POEM), eosinophilic esophagitis (>=15 eos/HPF; dupilumab 2022; swallowed topical steroids), peptic ulcer (Forrest classification; IV PPI bolus + drip), ACG 2024 H. pylori (bismuth quadruple first-line, rifabutin salvage), Zollinger-Ellison, celiac disease (tTG-IgA with total IgA), SIBO (hydrogen-methane breath test), tropical sprue, Whipple (Tropheryma whipplei), short bowel with teduglutide.

18%

Inflammatory Bowel Disease

UC classification (proctitis/left-sided/extensive/pancolitis), Crohn Montreal (A/L/B +/-p), biologics: anti-TNF (infliximab, adalimumab), anti-integrin vedolizumab, anti-IL-12/23 ustekinumab, IL-23p19 risankizumab (2022), mirikizumab (UC 2023, Crohn 2024), guselkumab (both indications 2024), JAK tofacitinib/upadacitinib, S1P modulators ozanimod/etrasimod. TDM, perianal fistula MRI + seton + anti-TNF, pouchitis (cipro or metronidazole; vedolizumab for CARP 2024), CRC surveillance 8 yrs from dx.

15%

Colon and Anorectum

USPSTF 2021 CRC screening at age 45 (colonoscopy q10, FIT annual, Cologuard q3, CT colonography q5). Lynch syndrome (MLH1, MSH2, MSH6, PMS2, EPCAM) q1-2 years. FAP (APC). USMSTF 2020 polyp surveillance (1-2 adenomas <10 mm: 7-10 yrs). Sessile serrated lesions via CpG island methylator pathway. C. difficile: fidaxomicin first-line (IDSA 2021), bezlotoxumab, FMT/REBYOTA/Vowst. Microscopic colitis (lymphocytic vs collagenous), diverticulitis (Hinchey; selective antibiotics), colonic ischemia, IBS with constipation/diarrhea.

15%

Pancreas and Biliary

Acute pancreatitis: Revised Atlanta, BISAP, Ranson, APACHE II; goal-directed lactated Ringer's resuscitation (WATERFALL). ERCP indications: cholangitis, persistent biliary obstruction. Chronic pancreatitis: M-ANNHEIM, PERT with lipase 40-50k units/meal, celiac plexus block. Autoimmune: type 1 (IgG4-RD) vs type 2 (duct-centric). Pancreatic cancer: FOLFIRINOX adjuvant (PRODIGE 24). IPMN/MCN: Fukuoka/Kyoto high-risk stigmata. Tokyo Guidelines for cholangitis. Cholangiocarcinoma (intrahepatic vs perihilar/Klatskin vs distal) with molecular targets (FGFR2, IDH1).

22%

Liver and Hepatology

HCV: pangenotypic DAAs (sofosbuvir/velpatasvir, glecaprevir/pibrentasvir) with >95% SVR. HBV: entecavir, TDF/TAF (TAF preferred for renal/bone/pregnancy). MASLD/MASH 2023 renaming; resmetirom (Rezdiffra) March 2024 for F2/F3. Alcoholic hepatitis: Maddrey >=32, prednisolone with Lille at day 7, early transplant. Cirrhosis: variceal prophylaxis (NSBB carvedilol or EVL), HE (lactulose + rifaximin), SBP (ceftriaxone + albumin), HRS-AKI (terlipressin + albumin), ascites (LVP with albumin, TIPS). AIH (prednisone + AZA), PBC (UDCA; second-line obeticholic, elafibranor, seladelpar 2024), PSC (MRCP/CA 19-9/annual colonoscopy), hemochromatosis (HFE C282Y, phlebotomy), Wilson (penicillamine/trientine), alpha-1 antitrypsin (PI*ZZ). HCC LI-RADS; atezolizumab + bevacizumab (IMbrave150).

Functional, Bleeding, Nutrition, and Endoscopy

IBS Rome IV: linaclotide, plecanatide, lubiprostone, tenapanor (IBS-C); rifaximin, eluxadoline, alosetron (IBS-D). Low FODMAP three-phase. Gastroparesis: metoclopramide <=12 weeks. Upper GIB: PPI drip + endoscopy; variceal (octreotide + ceftriaxone + EVL). Lower GIB: CT angiography, colonoscopy. Obscure/small bowel bleeding: capsule endoscopy + deep enteroscopy. Nutrition: PERT, PNALD with SMOFlipid. Sedation: flumazenil/naloxone reversal. Periprocedural DOAC (48-hour hold for high-risk). Post-ERCP pancreatitis: rectal indomethacin + LR. AIMS adverse event framework.

How to Pass the ABIM GI Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail; specific cut not published)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM GI Study Tips from Top Performers

1Master the highest-yield hepatology topics: HBV (treatment indications, antiviral choice TDF vs TAF vs entecavir, reactivation prophylaxis before rituximab/chemo), HCV (pangenotypic DAAs sofosbuvir/velpatasvir and glecaprevir/pibrentasvir, no more interferon), MASLD/MASH (2023 renaming; resmetirom FDA-approved March 2024 for F2/F3), and cirrhosis complications (varices NSBB/EVL, HE lactulose + rifaximin, SBP ceftriaxone + albumin, HRS-AKI terlipressin).

2Know IBD biologics by mechanism and indication: anti-TNF (infliximab, adalimumab), anti-integrin vedolizumab, IL-12/23 ustekinumab, IL-23p19 risankizumab (2022), mirikizumab/guselkumab (2024), JAK tofacitinib/upadacitinib (boxed warnings), S1P modulators ozanimod/etrasimod. Memorize therapeutic drug monitoring thresholds (infliximab 5-10, adalimumab 7-12 mcg/mL) and when to dose-escalate vs switch.

3Memorize the ACG 2024 H. pylori guideline: bismuth quadruple (PPI + bismuth + tetracycline + metronidazole x 10-14 days) is now preferred first-line in the US because clarithromycin resistance exceeds 15%. Rifabutin triple therapy (Talicia) is salvage. Always confirm eradication with urea breath test or fecal antigen 4 weeks after treatment and off PPI x 2 weeks.

4Master Chicago Classification v4.0 achalasia subtypes: Type I (failed peristalsis, no pressurization), Type II (panesophageal pressurization, best prognosis), Type III (spastic, requires longer myotomy — POEM preferred). Know Los Angeles grades of esophagitis (A <=5 mm, B >5 mm not crossing folds, C <75% circumference, D >=75%), Barrett surveillance every 3-5 years.

5Commit to memory the updated CRC screening (USPSTF 2021 age 45-75, Grade B), post-polypectomy intervals (USMSTF 2020: 1-2 tubular adenomas <10 mm — 7-10 years; SSL <10 mm without dysplasia 5-10 years; >=10 mm or dysplasia 3 years), and C. difficile management (fidaxomicin first-line per IDSA 2021, bezlotoxumab to reduce recurrence, FMT/REBYOTA/Vowst for multiply recurrent).

Frequently Asked Questions

Who is eligible for the ABIM Gastroenterology exam?

Candidates must hold current ABIM certification in Internal Medicine and must have completed a 3-year ACGME-accredited Gastroenterology fellowship. A valid, unrestricted US medical license and verification of clinical competence from the program director are required.

How often is the GI exam offered and how is it structured?

ABIM administers the Gastroenterology subspecialty exam annually. It is a single-day, computer-based exam at Pearson VUE containing approximately 220 single-best-answer MCQs delivered in four modules of roughly two hours each, with an overall ~10-hour exam day including tutorial and breaks.

What does the ABIM GI exam cost?

The ABIM application plus exam fee for Gastroenterology is approximately $2,990 in 2026. Late fees apply after the regular deadline. Check the current ABIM fee schedule, as fees change annually.

What is the pass rate for the ABIM GI boards?

ABIM-reported first-time pass rates for Gastroenterology have historically been in the 85-92% range, reflecting a fellowship-trained candidate pool. Pass rates for repeat takers are lower. See ABIM's annual pass-rate report for the most recent data.

What topics are highest yield on the GI boards?

Hepatology (HCV DAAs, HBV therapy, MASLD/MASH with resmetirom, cirrhosis complications, AIH/PBC/PSC, HCC with LI-RADS), IBD biologics (with TDM), updated ACG 2024 H. pylori guidance (bismuth quadruple), USPSTF 2021 CRC screening at age 45, Chicago Classification v4.0 achalasia, Barrett esophagus surveillance, and acute pancreatitis severity prediction are highest yield.

What references and resources are recommended for board prep?

Core references: Sleisenger and Fordtran's Gastrointestinal and Liver Disease, Yamada's Textbook of Gastroenterology, and AASLD guidelines for hepatology. ACG clinical guidelines and AGA practice guidelines are essential for current US practice. Board review courses: ACG Annual Meeting postgraduate course, Mayo Clinic GI Board Review, ASGE postgraduate courses. High-quality practice question banks with detailed rationales are critical for pattern recognition.

How do I maintain my GI certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — roughly 30 questions per quarter, open-book — or a traditional 10-year recertification exam. You must also keep your underlying Internal Medicine certification active and meet ABIM professional standing requirements.

Is GI certification worth it career-wise?

Yes for any gastroenterologist — GI board certification is a de facto requirement for hospital privileges, insurance credentialing, academic appointments, and endoscopy center contracts. Certified gastroenterologists consistently rank among the highest-compensated IM subspecialists with MGMA median around $500K-$550K, reflecting procedural volume and high demand for endoscopy.