Exams 1 and 2

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2006;4:523–525

CME ACTIVITIES Exams 1 and 2 Patrick S. Kamath, MD, Associate Editor, CME Section

CME Credits: The American Gastroenterological Association Institute (AGAI) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AGAI designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Faculty Disclosure: In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support of Continuing Medical Education, all faculty and planning partners must disclose any financial relationship(s) or other relationship(s) held within the past 12 months. The AGAI implements a mechanism to identify and resolve all conflicts of interest prior to delivering the educational activity to learners.

Instructions: Category 1 credit can be earned by reading the relevant articles and taking these CME examinations online at http:// www.cghjournal.org/content/cme.

Objectives: On completion of these activities, participants should be able to demonstrate an increase in or affirmation of their knowledge of clinical medicine and evaluate the appropriateness of the clinical information as it applies to the provision of patient care.

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CME ACTIVITIES

CLINICAL GASTROENTEROLOGY AND HEPATOLOGY Vol. 4, No. 5

The Long-term Efficacy of Pneumatic Dilatation and Heller Myotomy for the Treatment of Achalasia Vela MF, et al, Authors Test ID No.: 0009

Contact hours: 1.0

Expiration Date: May 31, 2007

Question 1: Which of the following is true regarding the pathophysiology of achalasia?

a. b. c. d. e.

Decreased neurons in the myenteric plexus Cholinergic neurons are usually affected Nitric oxide–producing neurons are spared Histology shows lack of inflammation Ganglion cells in the dorsal motor nucleus of the vagus are normal

Question 2: Which of the following is NOT true regarding evaluation of achalasia?

a. Barium studies are not useful in evaluation of achalasia b. On manometry, the resting esophageal pressure (LES) is ⬎45 mm Hg c. There is incomplete relaxation of the LES d. Manometry shows aperistalsis of the body of the esophagus e. Endoscopy might show esophageal candidiasis

Question 3: Which of the following is true regarding the endoscopic treatment of achalasia?

a. Pneumatic dilatation is best for patients ⬍40 years of age b. Botulinum toxin injection is best for patients ⬍40 years of age c. Complication rate of pneumatic dilatation is usually ⬍1% d. Goal of pneumatic dilatation is decrease of LES pressure to 20 mm Hg or less e. Vigorous achalasia is a predictor of favorable outcome after botulinum toxin injection

Question 4: All the following are true regarding surgical Heller myotomy for achalasia EXCEPT:

a. Long-term relief in symptoms with open Heller myotomy is ⬎85% at 10 years b. Mortality rates are similar to those observed with pneumatic dilatation c. Prevalence of gastroesophageal reflux post-treatment is similar to post-pneumatic dilatation d. Short-term success is similar between pneumatic dilatation and laparoscopic Heller myotomy e. Long-term success with both pneumatic dilatation and Heller myotomy declines over time