ʻO Achalasia kahi maʻi e kū ʻia ke hele a hele ʻole paha nā kuʻikahi esophageal, ʻaʻole hoʻomaha ka sphincter haʻahaʻa haʻahaʻa, a hoʻonui ʻia ka kaomi hoʻomaha o ka sphincter esophageal haʻahaʻa. ʻO ka pahuhopu o ka mālama ʻana e hōʻoluʻolu i nā ʻōuli ma ka hoʻoulu ʻana i ka sphincter esophageal haʻahaʻa, ma ke kī ʻana i ka botulinum toxin, me kahi pāluna, a i ʻole ka ʻoki ʻana i nā olonā o ka sphincter.

ʻO Achalasia, i kapa ʻia hoʻi he cardiospasm a i ʻole megaesophagus, kahi maʻi neʻe o ka esophagus, kahi i ʻike ʻia e ka manaʻo hōʻoluʻolu ke ale. He maʻi laha ʻole ia, ka nui o 9-10 / 100 poʻe. Hiki ke hōʻike ʻia i kēlā me kēia makahiki, i nā kāne a me nā wahine, me kahi kiʻekiʻe ma waena o 000 a 30 mau makahiki. Hoʻomaka ka hoʻomaka ʻana, ma kahi ala sneaky, ma waena o nā makahiki 40 a 20 a e loli iki i mau mahina a i ʻole mau makahiki.

I ka manawa i ale ʻia, hele ka ʻai i ka ʻōpū ma o nā kuʻikuʻi muscle esophageal rhythmic i kapa ʻia he peristalsis. A laila komo ka meaʻai i loko o ka ʻōpū ma o ka hāmama ʻana o ka sphincter esophageal lalo, kahi apo o ka mākia e paʻa ana i ka wēlau o ka esophagus i pani ʻia, i ʻole e kahe ka meaʻai a me ka ʻōpū o ka ʻōpū i luna. i loko o ka esophagus. Ke ale ʻoe, hoʻomaha maʻamau kēia sphincter e ʻae i nā meaʻai e hele i loko o ka ʻōpū.

I ka achalasia, ʻike mau ʻia nā ʻano ʻelua: 

• ka loaʻa ʻole o ke kuʻi ʻana o ka esophageal, a i ʻole aperistalsis, i kumu ʻia e ka hoʻohaʻahaʻa o nā ʻalolo i ka paia o ka esophagus;
• a me ka puka ʻole a i ʻole piha o ka sphincter esophageal haʻahaʻa. 

ʻO ka ʻōuli nui o achalasia ke ale nei i nā maʻi. Alakaʻi kēia i:

• ʻo ka dysphagia, ʻo ia hoʻi, kahi manaʻo o ka blockage ʻai i ka wā e ale ai a i ʻole ke hele ma waena o ka esophagus, aia ma 90% o ka poʻe me ka achalasia;
• nā regurgitation, keu hoʻi i ka wā hiamoe, o nā meaʻai i hoʻohemo ʻole ʻia a i ʻole nā ​​wai, i kū i loko o ka esophagus, aia ma 70% o nā hihia;
• i kekahi manawa constricting ʻeha umauma;
• inā hānai nā mea maʻi i ka meaʻai i loko o nā akemāmā, hiki i ka hopena ke kū i ka maʻi, ka maʻi o ka hanu hanu, ka bronchiectasis ie dilation o ka bronchi, a i ʻole ka inhalation pneumonia.

Hiki ke hoʻomau i kēia mau hōʻailona no nā makahiki he nui, intermittently a capricious, a kū me nā meaʻai paʻa a me / a i ʻole nā ​​wai. Hiki iā lākou ke hoʻomāhuahua iki a alakaʻi i ka liʻiliʻi i ke kaumaha o ke kaumaha a i ʻole ka undernutr. Kūleʻa nā ʻōnaehana hanu, e hoʻopili ana i 20 a 40% o nā maʻi.

Hoʻokumu ʻia ka hōʻailona o achalasia ma:

• kahi oesopastro-duodenal endoscopy exploration e hiki ai ke nānā i ka uhi o ka esophagus;
• kahi hoʻokolokolo x-ray o ka esophagus, kahi e hoʻomoe ai ka mea maʻi i ka barite, kahi X-ray opaque contrad medium, kahi mea e hiki ai ke ʻike i kahi esophagus dilated i ninini maikaʻi ʻole ʻia;
• a ʻo ka hope loa he manometry esophageal, ka mea e hiki ai, mahalo i kahi hulina, e ana i nā kaomi ma ka esophagus a me ke ʻano o ka hoʻomaha o ka sphincter esophageal haʻahaʻa. I ka hanana o achalasia, kahakaha ka manometry i ka loaʻa ʻole o ka hōʻemi esophageal i ka pane ʻana i ka ale ʻana i ka wai a me kahi pau a i ʻole piha ʻole o ka hoʻomaha o ka sphincter esophageal haʻahaʻa.

ʻAʻole hiki i kahi lapaʻau ke hoʻoponopono i nā hoʻololi pathophysiological kuleana no achalasia.

Hoʻolālā nā hana i manaʻo ʻia e hōʻoluʻolu i nā ʻōuli ma o ka hōʻemi ʻana i ke kaomi o ka sphincter esophageal haʻahaʻa a me ka hoʻomaikaʻi ʻana i ka hele ʻana o nā mea esophageal i ka ʻōpū ma o ka hopena umekaumaha:

• ka pahu o botulinum toxin i loko o ka sphincter esophageal lalo e ke ala endoscopic e ʻae iā ia e hoʻokuʻu. Kēia iapaau ana, hou i kēlā me kēia ʻeono a ʻumikūmālua mau mahina, kuhikuhi nui ʻia i nā mea maʻi palupalu ma ka ʻoki poepoe kiʻekiʻe.
• diloscope dilation, a i ʻole ka pneumatic dilation, e hoʻohana ana i kahi baluna i hoʻonoho ʻia ma ka huina esogastric i hoʻonui ʻia, a e ʻae ai e hoʻolōʻihi i nā mākala a paipai i ka hakahaka ʻana o ka esophagus. Kūpono ia ma kahi o 80 a 85% o nā hihia;
• myotomy ʻoki, i ʻike ʻia ʻo Heller, ka ʻoki ʻana i nā olonā o ka sphincter esophageal lalo e laparoscopy, kahi ʻenehana ʻoki e hiki ai i ke komo i loko o ka ʻōpū ma o nā ʻoki liʻiliʻi. ʻO kēia hana, i hana ʻia ma mua o 85% o nā hihia, pili pinepine ʻia me ka hana ʻana o ka pahu i ke kiʻekiʻe o ka hui esogastric e kaohi ai i ka makaʻu o ka reflux gastroesophageal;
• ʻo ka myotomy endoscopic peroral hou loa (POEM) kahi ʻoki i hana ʻia endoscopically. ʻO kēia ʻenehana, kūpono ma 90% o nā hihia, i loko o ka hana ʻana i kahi tunnel ma ka paia o ka esophagus i mea e komo pono ai i ka sphincter esophageal haʻahaʻa e ʻoki iā ia. 

Hiki i kekahi mau lāʻau lapaʻau lāʻau ke kōkua i ka hoʻomaha ʻana i ka sphincter. He palena palena ko lākou akā hiki ke hoʻolōʻihi i ka manawa ma waena o nā dilations balloon ʻelua a i ʻole nā ​​injections botulinum toxin. Hiki iā lākou ke noʻonoʻo ʻia i nā mea maʻi me ka contraindication i ke kaha ʻana a i ʻole ka endoscopic dilation, a i ka hanana o ka hana ʻole me ka lāʻau botulinum. Pākuʻi ʻia kēia mau mea:

• nā nitrates, e like me ka dinitrate isosorbide, e waiho ma lalo o ke alelo ma mua o ka ʻai ʻana; ʻike ʻia ka hoʻomaikaʻi ʻana o nā ʻōuli ma 53-87% o nā hihia;
• waiho ʻia nā kahawai kalipona, e like me nifedipine, ma lalo o ke alelo 30 a 45 mau minuke ma mua o ka pāʻina ʻana. Hōʻike ʻia ka hoʻomaikaʻi ʻana i ka dysphagia ma 53 a 90% o nā hihia.