100+ Free ABP Pediatric Gastroenterology Practice Questions

Pass your ABP Pediatric Gastroenterology Subspecialty Certifying Examination exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~85-90% first-attempt for ABP pediatric subspecialties (not broken out publicly) Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

A 6-year-old with chronic dysphagia and food impaction undergoes EGD; biopsies show ≥15 eosinophils per high-power field in the distal esophagus with trachealization and linear furrowing. Which diagnosis fits best?

Eosinophilic esophagitis (EoE)

GERD-associated esophagitis

Achalasia

Candida esophagitis

to track

2026 Statistics

Key Facts: ABP Pediatric Gastroenterology Exam

~200

Total MCQ Items

Single-best-answer, 4-5 options

~7 hr

Exam Time

1-day CBT at Pearson VUE

180

Passing Score

1-300 scale; criterion-referenced

$2,992

2026 Regular Fee

Includes $750 processing fee

3 yr

Required Fellowship

ACGME-accredited Pediatric GI fellowship

MOCA-Peds

Continuing Certification

5-year longitudinal assessment cycle

The ABP Pediatric Gastroenterology certifying exam is a 1-day computer-based test of approximately 200 single-best-answer MCQs delivered at Pearson VUE. Scored on a 1-300 scale with 180 passing (criterion-referenced, modified Angoff). The 2026 fee is $2,992 regular ($750 processing), $3,337 late. Highest-yield domains: IBD (~12%), esophagus/GERD/EoE/motility (~10%), stomach/small bowel (~8%), neonatal hepatology (~8%), older hepatology (~8%), nutrition/TPN (~8%), functional/motility (~8%), colon/constipation/Hirschsprung (~6%), pancreas (~5%), infectious GI (~5%), endoscopy (~5%), acute liver failure/transplant (~4%), tumors, FGIDs, CF GI, and immunology/VEO-IBD.

Sample ABP Pediatric Gastroenterology Practice Questions

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

1A 6-year-old with chronic dysphagia and food impaction undergoes EGD; biopsies show ≥15 eosinophils per high-power field in the distal esophagus with trachealization and linear furrowing. Which diagnosis fits best?

A.Eosinophilic esophagitis (EoE)

B.GERD-associated esophagitis

C.Achalasia

D.Candida esophagitis

Explanation: EoE is defined by ≥15 eosinophils/HPF in the esophagus with symptoms of esophageal dysfunction, after exclusion of other causes. Endoscopic features include trachealization (concentric rings), linear furrowing, white exudates, and strictures. Treatment options include topical swallowed steroids (budesonide, fluticasone), elimination diets (6-food or empiric), and dupilumab (FDA-approved pediatric 2022).

2Which biologic was FDA-approved in 2022 for pediatric (≥12 years) eosinophilic esophagitis?

A.Dupilumab

B.Infliximab

C.Vedolizumab

D.Omalizumab

Explanation: Dupilumab, an IL-4 receptor alpha antagonist blocking IL-4 and IL-13 signaling, was FDA-approved for EoE in adults and adolescents (≥12 yr, ≥40 kg) in 2022, and approval was extended to children 1-11 yr in 2024. It reduces eosinophilic inflammation and improves dysphagia symptoms.

3A 2-month-old with physiologic GER has normal weight gain and no red flags. What is the FIRST-line management?

A.Begin omeprazole daily

B.Reassurance, upright positioning after feeds, and thickened/smaller more frequent feeds

C.Nissen fundoplication

D.H2 blocker ranitidine

Explanation: In otherwise healthy infants with uncomplicated physiologic reflux (happy spitters), conservative measures — reassurance, positioning, thickened feeds, smaller more frequent feedings — are first-line. Evidence for PPIs in infants is limited and NASPGHAN/ESPGHAN guidelines discourage empiric acid suppression because placebo-controlled trials have shown no benefit for symptoms attributed to reflux in infants.

4A 14-year-old with progressive dysphagia to solids and liquids has a barium swallow showing a bird's beak at the GE junction and dilated esophagus. High-resolution manometry confirms absent peristalsis and failure of LES relaxation. Which is a definitive treatment option?

A.Dilation with Savary bougies only

B.Proton pump inhibitor therapy

C.Heller myotomy or peroral endoscopic myotomy (POEM)

D.Swallowed topical budesonide

Explanation: Achalasia is characterized by absent esophageal peristalsis and failure of LES relaxation. Definitive treatments include laparoscopic Heller myotomy (often with Dor or Toupet fundoplication) and peroral endoscopic myotomy (POEM). Pneumatic dilation is another option. Medical therapy (nitrates, CCBs) is temporizing.

5A newborn has excessive oral secretions and a coiled NG tube visible on chest X-ray in the upper esophageal pouch, with gas in the stomach. Which diagnosis?

A.Pure esophageal atresia (Type A)

B.Esophageal atresia with distal tracheoesophageal fistula (Type C)

C.H-type TEF without atresia

D.Duodenal atresia

Explanation: Type C (most common, ~85%) esophageal atresia has a proximal blind pouch and distal TEF from trachea to distal esophagus — inability to pass NG tube + gas in the abdomen (via the fistula) is classic. Pure atresia (Type A) shows gasless abdomen. Associated with VACTERL (Vertebral, Anal, Cardiac, TEF, Renal, Limb). H-type fistula has no atresia and presents later with recurrent aspiration.

6A toddler swallowed a household drain cleaner 3 hours ago. What is the appropriate initial management?

A.Immediate induction of emesis

B.NPO, IV fluids, and EGD within 24-48 hours to assess injury grade

C.Neutralization with weak acid

D.Oral activated charcoal

Explanation: For caustic (alkaline or acid) ingestion, induction of emesis and neutralization are CONTRAINDICATED (worsen injury). Management is NPO, IV fluids, airway assessment, and EGD within 12-48 hours to grade injury (Zargar 0-3). Steroids and antibiotics are controversial. Long-term complications include strictures and esophageal carcinoma (alkaline ingestions).

7A 3-year-old swallowed a button battery 4 hours ago; radiograph shows a double-rim/halo sign in the esophagus. What is the appropriate management?

A.Emergent endoscopic removal

B.Observe with serial radiographs for passage

C.Give honey only and discharge

D.Wait 24 hours then reassess

Explanation: A button battery lodged in the esophagus is a TRUE EMERGENCY — tissue necrosis from hydroxide generation can occur within 2 hours. Immediate endoscopic removal is indicated. Honey (5-10 mL every 10 min) can be given en route in children >12 months as a temporizing measure. Gastric batteries in asymptomatic children can usually be observed.

8Which endoscopic finding is MOST specific for eosinophilic esophagitis in children?

A.Owl-eye inclusions

B.Distal erosive linear ulcerations alone

C.Cobblestone mucosa

D.Fixed concentric rings (trachealization) with linear furrows and white exudates

Explanation: EoE endoscopic features — concentric rings (trachealization), linear furrows, white papular exudates, edema, strictures — are captured by the EREFS score. None are pathognomonic in isolation, but the combination in a child with dysphagia is highly suggestive. Biopsy with ≥15 eos/HPF confirms the diagnosis.

9In the six-food elimination diet (SFED) for eosinophilic esophagitis, which groups are excluded?

A.All animal proteins

B.Milk, meat, fruit, vegetables, fish, egg

C.Gluten, dairy, soy, corn, nuts, caffeine

D.Milk, wheat, egg, soy, nuts, and fish/shellfish

Explanation: The six-food elimination diet (SFED) removes the six most common food triggers of EoE: milk, wheat, egg, soy, nuts, and fish/shellfish. Step-down approaches (4-food, 2-food, or milk-only elimination) have gained popularity to reduce endoscopy burden. Milk is the most frequent single trigger in children.

10A 10-year-old with GERD refractory to high-dose PPIs, severe aspiration, and intellectual disability is considered for surgical management. Which procedure is MOST appropriate?

A.Roux-en-Y gastric bypass

B.Heller myotomy

C.Laparoscopic Nissen fundoplication

D.Pyloromyotomy

Explanation: Nissen fundoplication (360° wrap) is the standard surgical treatment for refractory GERD, especially in neurologically impaired children with aspiration. Partial wraps (Toupet 270°, Dor 180°) are alternatives. Complications include dysphagia, gas-bloat syndrome, wrap failure, and retching. Decision-making involves multidisciplinary assessment.

About the ABP Pediatric Gastroenterology Exam

The ABP Pediatric Gastroenterology subspecialty certifying exam validates expert-level knowledge of GERD, eosinophilic esophagitis (EoE, dupilumab), inflammatory bowel disease (Crohn, UC, VEO-IBD, biologics), celiac disease (ESPGHAN 2020 no-biopsy pathway), H. pylori, pediatric liver disease (biliary atresia/Kasai, Alagille, PFIC, α1-AT, Wilson, autoimmune hepatitis, MASLD, PALF, transplant), pancreatitis (INSPPIRE, hereditary), cystic fibrosis GI (PERT, DIOS, Trikafta), chronic constipation and Hirschsprung, functional GI disorders (Rome IV), motility, nutrition/TPN/IFALD, and endoscopy. 1-day CBT of ~200 MCQs. Requires ABP General Pediatrics certification plus a 3-year ACGME-accredited Pediatric GI fellowship.

Questions

200 scored questions

Time Limit

1-day CBT (~7 hours with breaks)

Passing Score

Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)

Exam Fee

$2,992 regular ($750 processing fee); $3,337 with late fee (American Board of Pediatrics (ABP) / Pearson VUE)

ABP Pediatric Gastroenterology Exam Content Outline

~12%

Inflammatory Bowel Disease (IBD)

Crohn vs UC (Paris classification), VEO-IBD <6y (IL-10R, XIAP, FOXP3, CGD, CVID), diagnosis (ileocolonoscopy + EGD + MRE), induction (EEN first-line pediatric Crohn, steroids, mesalamine UC), maintenance (thiopurines with TPMT/NUDT15, MTX, anti-TNF, vedolizumab, ustekinumab, JAK inhibitors), perianal, EIM, surveillance.

~10%

Esophagus: GERD, EoE, Motility

GERD (NASPGHAN 2018, PPIs, pH-MII, fundoplication), eosinophilic esophagitis (≥15 eos/HPF per 2018 AGREE consensus; 6-food/milk elimination, swallowed fluticasone/budesonide, dupilumab ≥1y/≥15kg), achalasia (manometry 1-3, Heller/POEM), eosinophilic gastroenteritis.

~8%

Stomach and Small Intestine

Celiac (ESPGHAN 2020 no-biopsy: TTG IgA >10x ULN + EMA+, HLA-DQ2/DQ8), pediatric H. pylori (ESPGHAN 2017 treat only if PUD), PUD, SMA syndrome, Meckel (Tc scan), intussusception, malrotation/volvulus, short bowel syndrome (teduglutide GLP-2).

~8%

Hepatology — Neonatal / Cholestasis

Biliary atresia (Kasai HPE ideally <60 days), Alagille (JAG1/NOTCH2 — butterfly vertebrae, posterior embryotoxon, peripheral pulmonary stenosis), PFIC 1-6, neonatal hepatitis, choledochal cysts (Todani), α1-AT (PiZZ, PAS-D), CFLD.

~8%

Hepatology — Older Children

Autoimmune hepatitis (type 1 ANA/ASMA, type 2 LKM-1; prednisone + azathioprine), Wilson (ATP7B, KF rings, ceruloplasmin <20, liver Cu >250 µg/g; chelation), MASLD (pediatric NAFLD), viral hepatitis (HBV, HCV DAAs), portal hypertension/varices, ascites.

~8%

Nutrition, Enteral/Parenteral

Nutritional assessment, enteral feeding (NG/NJ/G/GJ-tubes), formula (semi-elemental, elemental, amino acid — Elecare, Neocate), TPN (dextrose, amino acids, lipid emulsions SMOF/Omegaven, IFALD), micronutrient deficiencies, refeeding.

~6%

Colon and Anorectum

Chronic functional constipation (Rome IV; NASPGHAN/ESPGHAN 2014 PEG 3350 first-line), encopresis, Hirschsprung (rectal suction biopsy — absent ganglion cells, calretinin/AChE), juvenile polyps vs syndromic (PJS STK11, JPS BMPR1A/SMAD4, FAP APC, Cowden PTEN).

~5%

Pancreas

Acute pancreatitis (INSPPIRE etiology), hereditary pancreatitis (PRSS1, SPINK1, CFTR, CTRC), pancreatic insufficiency (CF — PERT pancrelipase 500-2500 U/kg/meal, Shwachman-Diamond SBDS, Johanson-Blizzard), congenital hyperinsulinism.

~5%

Infectious Gastroenteritis and Diarrhea

Viral (rotavirus vaccine, norovirus, adenovirus), bacterial (Salmonella, Shigella, Campylobacter, STEC O157:H7 HUS risk, C. diff — fidaxomicin), parasitic (Giardia, Crypto, E. histolytica), chronic diarrhea, malabsorption (lactose breath test, PLE α1-AT clearance), congenital diarrheas.

~5%

Endoscopy and Procedures

EGD, colonoscopy, capsule endoscopy, ERCP/EUS, pediatric sedation, polypectomy, variceal banding, PEG/GJ, button battery emergency (AAP — esophageal removal <2h), caustic ingestion (no induced emesis, early endoscopy).

~4%

Acute Liver Failure and Transplant

PALF (INR ≥2 not corrected by vit K + hepatocellular injury), etiology (indeterminate, metabolic, viral, acetaminophen, autoimmune, HLH), transplant indications, PELD, tacrolimus, rejection, PTLD, recurrence.

~4%

Functional GI Disorders (Rome IV)

Infant regurgitation, rumination, colic; functional constipation; cyclic vomiting; child/adolescent functional dyspepsia, IBS-D/C/M, functional abdominal pain, abdominal migraine; biopsychosocial, neuromodulators, CBT, hypnotherapy.

~4%

Motility Disorders

Pediatric intestinal pseudo-obstruction, neuropathic vs myopathic, gastroparesis (scintigraphy), esophageal dysmotility, anorectal manometry (rectoanal inhibitory reflex absent in Hirschsprung), HRM.

~3%

Cystic Fibrosis GI

Meconium ileus, DIOS (gastrografin enema), pancreatic insufficiency (PERT), CFLD (focal biliary cirrhosis), rectal prolapse, CFTR modulators (elexacaftor/tezacaftor/ivacaftor — Trikafta).

~3%

Tumors and Genetics/Immunology

Hepatoblastoma (AFP, PRETEXT), fibrolamellar HCC (DNAJB1-PRKACA), solid pseudopapillary pancreatic, lymphoma (ileocecal Burkitt); polyposis (PJS, FAP, JPS); VEO-IBD immunodeficiency workup; FPIES, FPIAP; celiac HLA-DQ2/DQ8.

How to Pass the ABP Pediatric Gastroenterology Exam

What You Need to Know

Passing score: Scaled score of 180 on a 1-300 scale (criterion-referenced, modified Angoff)
Exam length: 200 questions
Time limit: 1-day CBT (~7 hours with breaks)
Exam fee: $2,992 regular ($750 processing fee); $3,337 with late 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

ABP Pediatric Gastroenterology Study Tips from Top Performers

1EoE 2018 AGREE consensus key change: the PPI-REE (PPI-responsive esophageal eosinophilia) is NO LONGER a separate entity — it is now EoE. Diagnosis requires symptoms + ≥15 eos/HPF on esophageal biopsy + exclusion of other causes (no need for PPI trial before diagnosis). Initial treatment: PPI, 6-food or milk elimination diet, or swallowed topical steroids (fluticasone or orodispersible budesonide — Eohilia). Dupilumab is FDA-approved for EoE ≥1 year and ≥15 kg as of 2024.

2VEO-IBD rule: IBD onset <6 years (especially <2 years) warrants immunodeficiency evaluation. Key monogenic causes include IL-10 and IL-10R mutations (very severe, early-onset, perianal; HSCT curative), XIAP, FOXP3 (IPEX — enteropathy + endocrinopathy + dermatitis), CGD (NADPH oxidase — dihydrorhodamine test), CVID. Obtain immune workup (IgG/A/M, DHR, lymphocyte subsets, functional tests) and consider whole exome sequencing.

3ESPGHAN 2020 celiac no-biopsy pathway: in symptomatic children, diagnosis WITHOUT biopsy requires (1) TTG-IgA ≥10x upper limit of normal AND (2) positive EMA on a second sample. HLA-DQ2/DQ8 is no longer required to omit biopsy but can be used to rule out celiac. Always measure total serum IgA first (IgA deficiency is common). In IgA-deficient patients, use IgG-based tests (DGP-IgG, TTG-IgG).

4Biliary atresia management pearl: the Kasai hepatoportoenterostomy works best when performed before 60 days of age (bile drainage success drops significantly after 90 days). Evaluation of the cholestatic neonate must include split bilirubin (conjugated >1 mg/dL = never normal), ultrasound (triangular cord sign, absent gallbladder), HIDA scan (no small bowel excretion at 24h suggests BA), and ultimately intraoperative cholangiography. PFIC panel (ATP8B1, ABCB11, ABCB4, TJP2, NR1H4, MYO5B) is indicated if ultrasound and HIDA do not confirm BA.

5Wilson disease diagnostic approach: ceruloplasmin <20 mg/dL is supportive but not diagnostic (false negatives in acute inflammation, false positives in estrogen states). Kayser-Fleischer rings on slit-lamp exam are highly specific. 24-hour urine copper >100 µg (or >40 µg with penicillamine challenge) supports diagnosis. Liver copper >250 µg/g dry weight is confirmatory. Leipzig score ≥4 = diagnosis. Treatment: chelation with D-penicillamine or trientine; zinc for maintenance. Screen all first-degree relatives with ATP7B sequencing.

Frequently Asked Questions

What is the ABP Pediatric Gastroenterology subspecialty certification?

The ABP Pediatric Gastroenterology certification is awarded by the American Board of Pediatrics to pediatricians who demonstrate expert knowledge in the diagnosis and management of GI, liver, pancreatic, and nutritional disorders in children and adolescents. It qualifies diplomates to perform pediatric endoscopy, manage IBD/EoE/hepatology patients, and lead pediatric GI services at children's hospitals.

Who is eligible to take the ABP Pediatric Gastroenterology exam?

Candidates must hold primary ABP General Pediatrics certification in good standing and have completed 3 years of full-time training in an ACGME-accredited Pediatric Gastroenterology fellowship. A valid unrestricted medical license is required. The fellowship includes clinical GI/hepatology/nutrition, endoscopy (EGD and colonoscopy) competency, and scholarly activity meeting the ABP scholarly requirement.

What is the format of the ABP Pediatric Gastroenterology exam?

It is a 1-day computer-based exam administered at Pearson VUE Professional Testing Centers, consisting of approximately 200 single-best-answer multiple-choice questions. Items include clinical vignettes with endoscopy/imaging (MRE, US, MRCP), liver biopsy histology, pH-MII tracings, motility manometry, and pharmacology (biologics, CFTR modulators, Trikafta, dupilumab, teduglutide).

How much does the 2026 ABP Pediatric Gastroenterology exam cost?

The 2026 regular registration fee is $2,992, which includes a $750 nonrefundable processing fee. Late registration is $3,337 (includes a $345 late fee). Pediatric GI is administered as an ABP subspecialty exam at Pearson VUE centers in 2026.

How is the exam scored?

The exam is scored on a 1-300 scale with 180 designated as the passing mark. ABP uses a criterion-referenced scoring model: a panel of practicing, board-certified pediatric gastroenterologists determines the passing standard using the modified Angoff method. Results are reported as scaled scores, not percentile ranks.

What are the highest-yield topics?

IBD (~12%), esophagus/EoE/GERD (~10%), stomach/small bowel (~8%), neonatal hepatology (~8%), older hepatology (~8%), and nutrition/TPN (~8%) together cover about half the exam. Master pediatric Crohn/UC management (EEN induction, biologics), EoE diagnosis and dupilumab, ESPGHAN 2020 celiac no-biopsy pathway, biliary atresia Kasai timing, Wilson disease (ATP7B, ceruloplasmin, 24-hour urine Cu, liver Cu >250 µg/g), PFIC panel, hereditary pancreatitis (PRSS1), and CF GI management with CFTR modulators.

How should I study for this exam?

Use a 6-12 month structured plan. Start with IBD, EoE, and celiac disease (highest-yield, daily practice). Move to hepatology (neonatal cholestasis → Wilson/AIH/MASLD → PALF/transplant). Then nutrition/TPN, motility (Hirschsprung, Rome IV FGIDs), pancreas, and CF GI. Finish with endoscopy (button battery, caustic ingestion), polyposis syndromes, VEO-IBD immunology, and tumors. Take 2-3 timed full-length mock exams. Integrate the NASPGHAN Board Review Course, Walker's Pediatric Gastrointestinal Disease, Suchy Liver Disease in Children, and NASPGHAN/ESPGHAN guidelines.

What are my continuing certification requirements after passing?

After initial certification, diplomates maintain certification via the ABP's Maintenance of Certification Assessment for Pediatricians (MOCA-Peds) — a longitudinal assessment with quarterly questions over a 5-year cycle. Diplomates must also complete Part 2 (self-assessment CME) and Part 4 (improvement in medical practice) activities and maintain an unrestricted license.