American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be considered for patients with a persistent esophageal stricture despite medical therapy?

1. Increased dosage of proton pump inhibitors

2. Esophageal dilation

3. Surgical esophagectomy

4. Observation with follow-up

The correct answer is: Esophageal dilation

In cases of persistent esophageal stricture that do not respond to medical therapy, esophageal dilation is a key intervention to consider. Esophageal strictures often arise from conditions such as gastroesophageal reflux disease (GERD), which may lead to scarring and narrowing of the esophagus. When medical treatments, particularly those aimed at managing underlying inflammation or acid exposure, fail to alleviate the stricture, mechanical dilation becomes necessary. Esophageal dilation can be performed using various techniques, including balloon dilation or bougie dilation. This procedure increases the luminal diameter of the esophagus, allowing for improved swallowing and relief from symptoms associated with the stricture. Additionally, dilation can be a repeated procedure if the stricture recurs, making it a viable long-term management option. In contrast, simply increasing the dosage of proton pump inhibitors may not effectively resolve a stricture that already exists, especially if it is a structural issue rather than solely related to acid exposure. Surgical options, like esophagectomy, are typically reserved for more severe cases or when there is a suspicion of malignancy, making them less appropriate for a straightforward stricture without other complicating factors. Observation is not suitable in the presence of ongoing symptoms or complications from the stricture, necessitating active