I-Achalasia yintlupheko ye-motility ye- esopha ebangela ubunzima bokugwinya kunye nezinye iingxaki. I-Achalasia yintlupheko engaqhelekiyo eyenzekayo xa iiseliti zesisongela esisegulini zihlahloka.
Ayaziwa ukuba kutheni iiseli zesiswini ziqala ukuhlakala kodwa ukulahlekelwa kwezi iiseli kubangela ukungasebenzi kwemisipha kwindawo kunye nokungakwazi kwe-sphincter esezantsi (VERS) ukuvala ngokufanelekileyo.
I-LES isivumelwano sokuvulwa, ukuvumela ukutya ukuba kungene kwisisu ukusuka kwi-esophagus kwaye emva koko kuvule ukuvalwa ukuze kugcinwe okuqukethwe kokutya ukubuyela kwisigxina.
Ngowe-1929 xa oogqirha befumene ukuba imbangela ye-achalasia yayingenakwenzeka ukuba i-LES ivalwe ngokufanelekileyo ibiza ngokuthi imeko ye-achalasia, oku kuthetha ukungaphumeleli.
I-Achalasia inokufumana ilifa kwabanye abantu kodwa ngokuqhelekileyo, lwenzeka kumabini kunye nabasetyhini abadala abadala. Iziganeko ziqikelelwa ukuba zi-1 kubantu abayi-100 000 ngonyaka. Usulelo oluthiwa yiChagas lungabangela i-achalasia.
Kwakhona kubalulekile ukwazi ukuba i-achalasia ngezinye izihlandlo ingabonakali njenge-gastroesophageal dislude disorder ( GERD ). Ukuxilongwa kwangaphambili kwe-achalasia kubaluleke kakhulu, njengoko i-achalasia inokunyusa umngcipheko wokuba nomhlaza wesifo .
Iimpawu
Ukuba ufumana i-achalasia unokufumana enye okanye ngaphezulu kwezi zimpawu ezilandelayo:
- I-Acid reflux okanye i-heartburn
- Ukuhlaziywa kwesisu esiswini
- Ukukhwehlela rhoqo
- Unzima ukugwinya
- Ukukhethwa
- Ukuziva ngathi ukutya kufakwe kwisifuba
- Ukuvakalelwa ngathi kukho ihlazo emqaleni wakho
- Ukulahlekelwa kwesisindo esingenziyo kunye / okanye ukungondleki
Ukuxilongwa
Ugqirha wakho usenokukrokrela i-achalasia ngokusekelwe kwiimpawu zakho kunye nokuhlolwa komzimba.
I-Achalasia kufuneka ikhunjulwe ukuba unobungozi bokugwinya zombini iziqulatho kunye nezixhobo zamanzi kwaye uvuselele ngokungahambisani nxamnye nonyango kunye neproton pump inhibitors. Iproton pump inhibitors yiklasi lemichiza edla ngokusetyenziswa ukuphatha i-reflux ye-asidi kunye ne- Prilosec , Nexium , kunye ne- Dexilant .
Ezi zilingo zilandelayo zikunceda ukuxilonga le meko:
Unyango
Iingcebiso zamanje zonyango lwe-achalasia ziquka ukuhluthwa kwe-pneumatic or orotomy. Ezi nkqubo zengqungquthela ziye zaboniswa ukuba zonyango oluchanekileyo (ulwazi oluninzi malunga nale nkqubo ilapha ngezantsi).
Kulabo abanako ukuhlinzwa okanye ukhethe ukungena, iinjongo zeBotox zilandelwe unyango kunye namachiza kucetyiswa.
Okwangoku akukho nonyango ekhoyo ekwazi ukubuyisela umsebenzi oqhelekileyo we-muscle (peristalsis) kwisigxina. Ngoko ke, zonke iinkatho zonyango zijoliswe ekunciphiseni uxinzelelo kwi-LES.
- Ukutshitshiswa kwe-myotomy yinkqubo engavumelaniyo apho i-fibric muscle ye-LES ihlulwe. Ingenziwa i-laparoscopically eyanciphisa ixesha lokubuyisela. Izifundo zibonise ukuba i-myotomy yokusebenza iphumelele kakhulu ekunciphiseni iimpawu ze-achalasia kodwa ukuphuhliswa kwe-GERD emva kokuba le nkqubo ivele rhoqo. Ngesi sizathu, kucetyiswa ukuba i-myotomy yenziwa ngenye indlela ebizwa ngokuba yi- fundallication ye- partial ukukhusela iGERD.
- Ukuxilongwa kwe-pneumatic (PD) yinkqubo engeyiyo yophenyo esebenzisa ingcinezelo yomoya ukuze iphazamise iintambo ze-muscle kwi-LES. Inkqubo eyenziwa isebenzisa ubude bendalo. Kukho umngcipheko wokuphazamisa i-esophagus (ngokuphazamisa ngephupha, okanye ukwenza imbobo kuyo) kwaye emva kwenkqubo, kufuneka ube ne-esophagram ye-barium ukuqinisekisa ukuba i-oopopus ayizange iguqulwe. Izifundo zibonisa ukuba xa kwenziwa kakuhle iPD inika kakuhle ukukhululeka okukhulu kweempawu ze-achalasia. Iziphumo azikho isigxina kodwa zingadlulela iminyaka.
- Ukuxilwa kwe-Esophageal kufana nokuhluthwa kwe-pneumatic kodwa ngexesha lokunyuka kwe-esophageal , ugqirha ulula i-LES kunye ne dilator. Ezinye izigulane ziyakhula i-GERD emva kwenkqubo.
- Iibyox ze-Botox ziye zaboniswa ukunciphisa uxinzelelo kwi-LES kodwa azisebenzi kakuhle njengePD okanye utyando. Iilenki zenziwa endoscopically kwaye isibheno esikhulu senkqubo kukuba kukho ezimbalwa iziphumo eziphantsi, umngcipheko ophantsi weengxaki, kunye nokuphucula ngokuqhelekileyo ngokukhawuleza kwaye kunzima. Iimpawu zisoloko ziqhubeka kwaye iilisi ezilandelayo zifunekayo kubantu abaninzi abakhetha olu unyango.
- I-Esophagectomy , okanye ukukhutshwa ngokugqithisileyo kwe-esophagus (okanye iinxalenye ze-esophagus), igcinwe kwiimeko ezinzima apho ezinye iindlela zonyango ziye zahluleka.
- Ukulawulwa kwemithi ye-achalasia kuthathwa njengendlela encinci yokulawula iimpawu. Nangona kunjalo, abo bangakwazi ukuhlinzwa kunye nabanikwe unyango lwe-botox olungenamsebenzi onokusetyenziswa. Imithi ebizwa ngokuthi i-calcium channel blockers, eyaziwayo ngokubhekisele kwixinzelelo legazi eliphezulu, isetyenziswa rhoqo kwi-achalasia ngenxa yokukwazi ukuphucula imisipha. Ukuphumla oku kunciphisa uxinzelelo kwi-LES. Olunye unyango oluthiwa yi-sildenafil (i-Viagra) luye lwaboniswa ukunciphisa uxinzelelo kwi-LES. Amanye amayeza angasetyenziselwa kuxhomekeke kwimeko kunye nokuqonda ngogqirha wakho.
Ngenxa yengozi yokwanda komdlavuza we-esophageal, zonke izigulane ezine-achalasia kufuneka zibe nohambo olulandelayo lokutyelela noogqirha babo, nangona xa unyango lusebenza kakuhle. Ugqirha wakho uya kubeka iliso kunye neskrini (njengoko kufanelekile) somhlaza wesisu.
Imithombo:
Ikholeji yaseMerika yaseGastroenterology. I-ACG Isikhokelo seZikliniki: Ukuxilongwa noLawulo lweAkaya. http://d2j7fjepcxuj0a.cloudfront.net/wp-content/uploads/2013/07/ACG_Guideline_Achalasia_July_2013.pdf
Medline Plus. Achalasia. http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
Medscape. Achalasia. https://reference.medscape.com/article/169974-overview#aw2aab6b2b4aa
Isemgangathweno. Ulwazi lweMonde: IAkayalasia (Ngaphandle kweZiseko). http://www.uptodate.com/contents/achalasia-beyond-the-basics