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A 60 year old man presents with a 4 month history of dysphagia and weight loss. A diagnosis of achalasia is made. Which of the following is the best way to provide symptomatic relief?
A. Surgical cardiomyotomy
B. Propanolol
C. Isosorbide mononitrate
D. Gaviscon
E. Magnesium trisilicate
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best way to provide symptomatic relief= Surgical cardiomyotomy?
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Answer: a) Surgical cardiomyotomy. Cardiomyotomy entails surgical division of the lower oesophageal sphincter. Mortality rates of less than 1% and success rates of over 85% have been recorded. There is however a high incidence (up to 10%) of oesophageal reflux post-operatively progressing in a number of cases to peptic stricture. For achalasia, nitrates and hydralazine can help in short term.