American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary goal of treatment for achalasia?

1. Elimination of gastric reflux

2. Improvement of esophageal motility

3. Reduction of esophageal pressure

4. Decreased incidence of ulcers

The correct answer is: Reduction of esophageal pressure

The primary goal of treatment for achalasia is to reduce esophageal pressure, particularly from the lower esophageal sphincter (LES). In achalasia, the LES fails to relax properly during swallowing, which leads to difficulty in food passage from the esophagus into the stomach. This condition is characterized by elevated resting pressure in the LES and impaired esophageal motility. Effective treatment options, such as pneumatic dilation or surgical myotomy, aim to lower this pressure, allowing for better passage of food and alleviating symptoms such as dysphagia (difficulty swallowing), chest pain, and regurgitation. By decreasing the pressure at the LES, the treatments significantly improve the functional status of the esophagus and enhance the patient's quality of life. The other options, while relevant to different aspects of gastrointestinal health or other conditions, do not capture the specific therapeutic focus in achalasia. For example, while improving esophageal motility is desirable and can occur as a secondary effect of treatment, it is not the primary treatment goal. Similarly, while gastric reflux may be a concern for other esophageal disorders, it is not directly addressed as a primary aim in achalasia management. Reducing the incidence of ulcers relates more to conditions like peptic ulcer disease