American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended treatment for esophageal dysmotility in patients with MCTD?

1. Calcium Channel Blockers

2. PPI

3. Glucocorticoids

4. Azathioprine

The correct answer is: PPI

In patients with mixed connective tissue disease (MCTD), esophageal dysmotility is a common manifestation due to the involvement of smooth muscle and the neuromuscular junction. The esophagus is particularly affected, leading to conditions such as dysphagia (difficulty swallowing) and gastroesophageal reflux. The recommended treatment for esophageal dysmotility in this context typically involves the use of proton pump inhibitors (PPIs). PPIs work by reducing gastric acid secretion, which can alleviate symptoms related to gastroesophageal reflux that often accompanies esophageal dysmotility. By decreasing acid exposure in the esophagus, PPIs help to reduce irritation and inflammation, thus providing relief from symptoms such as heartburn and discomfort. While other treatment options do exist, such as glucocorticoids or immunosuppressive agents like azathioprine, they are more focused on managing the underlying autoimmune components of MCTD rather than specifically addressing esophageal motility issues. Calcium channel blockers may also have some role in promoting muscle relaxation, but they are not typically the first-line treatment for esophageal dysmotility in this patient population. Therefore, the use of PPIs is favored for symptomatic relief directly related to esophageal dysmotility in individuals with