I-Achalasia iyinkinga ye-motility ye- esophagus ebangela ubunzima ukugwinya nezinye izinkinga. I-Achalasia iyisifo esingajwayelekile lapho kwenzeka lapho amangqamuzana omzimba egazini ehla.
Ayaziwa ukuthi kungani amangqamuzana egeyimu eqala ukwehla kodwa ukulahlekelwa kwalawa maseli kuholela ekusebenziseni imisipha engxenyeni kanye nokuhluleka kwe-sphincter esezansi ephansi (LES) ukuvala kahle.
I-LES ngokuvamile ivumelanise ukuvula, ivumela ukudla ukungena esiswini ukusuka esophagus bese kuvula ukuvala ukuze kugcinwe okuqukethwe kokudla ukubuyela emuva.
Ngo-1929 lapho odokotela bethola ukuthi imbangela ye-achalasia yayiyihluleka kwe-LES ukuvala kahle babiza isimo se-achalasia, okusho ukwehluleka ukuphumula.
I-Achalasia ingase izuzwe njengefa kwabanye abantu kodwa ngokuvamile, ivela kokubili amadoda nabesifazane abadala asebekhulile. Isibalo silinganiselwa ukuthi singaba-1 kwabangu-100,000 abantu ngonyaka. Ukutheleleka okuthiwa i-Chagas nakho kungabangela i-achalasia.
Kubalulekile ukwazi ukuthi i-achalasia ngezinye izikhathi ingabhekwa njenge-reflux disorder ( GERD ) ye- gastroesophageal . Ukuxilongwa kokuqala kwe-achalasia kubaluleke kakhulu, njengoba i-achalasia ingandisa ingozi yakho yokuthola umdlavuza wesifo .
Izimpawu
Uma uhlushwa yi-achalasia ungase uthole enye noma ngaphezulu yalezi zimpawu ezilandelayo:
- I-reflux ye-Acid noma i-heartburn
- Ukuvuselelwa kokuqukethwe kwesisu
- Ukukhwehlela njalo
- Kunzima ukugwinya
- Ukuchofoza
- Ukuzwa njengokudla kufakwe esifubeni
- Uzizwa sengathi uhlale ugoce emqaleni wakho
- Ukulahlekelwa kwesisindo okungenasisekelo kanye / noma ukungondleki
Ukuxilongwa
Udokotela wakho angase asole isikhala se-achalasia esekelwe ezimpawu zakho nokuhlolwa komzimba.
I-Achalasia kufanele ifolwe uma kunzima ukugwinya kokubili izinyosi nezidakamizwa futhi uphinde ubuyekeze ukwedlula ukwelashwa ngeproton pump inhibitors. I-Proton pump inhibitors yilasilasi lemithi ejwayele ukusetshenziselwa ukwelapha i-acid reflux futhi ihlanganisa i- Prilosec , Nexium , ne- Dexilant .
Ukuhlolwa okulandelayo kusiza ukuxilonga lesi simo:
Ukwelapha
Izincomo zamanje zokwelashwa kwe-achalasia zibandakanya ukuxilongwa kwe-pneumatic graft noma i-myotomy yokuhlinzeka nge-fundoplication eyingxenye. Lezi zinqubo zokuziqhenya ziye zaboniswa ukuthi zindlela zokwelapha eziphumelela kakhulu (olunye ulwazi mayelana nalezi zinqubo ezingezansi).
Kulabo abangakwazi ukuhlinzwa noma ukukhetha ukungenzi, izilonda ze-botox zilandelwe ukwelashwa ngemithi Kunconywa.
Okwamanje akakho ukwelashwa okukhona okukwazi ukubuyisela umsebenzi ojwayelekile we-muscle (peristalsis) ku-esophagus. Ngakho-ke, zonke izindlela zokwelashwa zihlose ukunciphisa ingcindezi ku-LES.
- Ukuhlinzwa i-myotomy kuyindlela engavumelani lapho ama-muscle fibers we-LES ehlukaniswa khona. Kungenziwa i- laparoscopically okuyinto ehlisa isikhathi sokuphumula. Ucwaningo lubonise ukuthi i-myotomy yokusebenza iphumelela kakhulu ekunciphiseni izimpawu ze-achalasia kodwa ukuthuthukiswa kwe-GERD ngemuva kwalokhu le nqubo ivele njalo. Ngenxa yalesi sizathu, kunconywa ukuthi i-myotomy yokuhlinzwa yenziwa kanye nenye inqubo ebizwa ngokuthi i- fundallication ye- partial ukuvimbela i-GERD.
- Ukunciphisa umoya (PD) kuyinkqubo engeyona yokuhlinzwa esebenzisa ukucindezela emoyeni ukuphazamisa amafayili emisipha e-LES. Inqubo yenziwa ngokusebenzisa i-sedation elula. Kukhona ingozi yokuphazamisa i-esophagus (ngokungahambi ngephutha, noma ukwenza imbobo kuyo) futhi emva kwenkambiso, kufanele ube ne-esophagram ye-barium ukuze uqiniseke ukuthi i-osopha ayizange iqhutshwe. Ucwaningo lubonisa ukuthi uma kwenziwa kahle i-PD inikeza kahle ukukhululeka okukhulu kwezimpawu ze-achalasia. Imiphumela ayilona unomphela kodwa ingahlala iminyaka.
- Ukuhlukumeza ngokweqile kufana nokunciphisa umoya kodwa ngesikhathi sokuxilonga , udokotela welula i-LES ne-dilator. Ezinye iziguli zingathuthukisa i-GERD ngemuva kwalokhu kwenqubo.
- I-Botox injection iye yaboniswa ukunciphisa ingcindezi ku-LES kodwa ayiphumelelanga njenge-PD noma ukuhlinzwa. Izijovo zenziwa endoscopically futhi isikhalazo esikhulu senqubo yukuthi kunezinto ezimbalwa eziyimiphumela emibi, ingozi encane yezinkinga, nokuphumula ngokuvamile kuvamile futhi kube nzima. Izimpawu zivame ukuphindwa futhi zithathelwe izijoka ezilandelayo kubantu abaningi abakhetha lokhu ukwelashwa.
- I-Esophagectomy , noma ukukhishwa okuhlinzekwayo kwe-esophagus (noma izingxenye ze-esophagus), kugcinwe amacala amakhulu lapho ezinye izikwelapha zihlulekile.
- Ukuphathwa kwemithi ye-achalasia kubhekwa njengendlela engcono kakhulu yokulawula izimpawu. Kodwa-ke, kulabo abangakwazi ukuhlinzwa kanye nokuthi imishanguzo ye-botox ayilungele yini imithi ingasetshenziswa. Imithi ebizwa ngokuthi i-calcium channel blockers, ejwayele ukushicilelwa ukucindezelwa kwegazi eliphezulu, ijwayele ukusetshenziselwa i-achalasia ngenxa yokukwazi ukuphumula imisipha elula. Lokhu kuphumula kuyanciphisa ukucindezelwa ku-LES. Omunye umuthi okuthiwa i-sildenafil (i-Viagra) uye waboniswa ukunciphisa ingcindezi ku-LES. Eminye imithi ingasetshenziswa kuye ngokuthi isimo kanye nokuqonda kukadokotela wakho.
Ngenxa yengozi yokukhula komdlavuza we-esophageal, zonke iziguli ezine-achalasia kufanele zibe nokuvakashelwa okujwayelekile okulandelwayo nodokotela wabo, ngisho nalapho ukwelashwa kusebenza kahle. Udokotela wakho uzoqapha kanye neskrini (uma kufanelekile) ngomdlavuza wokuqeda.
Imithombo:
I-American College of Gastroenterology. Umhlahlandlela wezokwelapha we-ACG: Ukuxilongwa nokuphathwa kwe-Achalasia. http://d2j7fjepcxuj0a.cloudfront.net/wp-content/uploads/2013/07/ACG_Guideline_Achalasia_July_2013.pdf
I-Medline Plus. I-Achalasia. http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
I-Medscape. I-Achalasia. https://reference.medscape.com/article/169974-overview#aw2aab6b2b4aa
Kusesikhathini. Ulwazi lokubekezela: i-Achalasia (Ngaphandle Kwezinto Eziyisisekelo). http://www.uptodate.com/contents/achalasia-beyond-the-basics