Achalasia chirwere chinoitika kana esophageal contractions isipo kana kuti isina kujairika, iyo yepasi esophageal sphincter haina kuzorora kazhinji, uye kuzorora kwekumanikidza kwepasi esophageal sphincter inowedzera. Chinangwa chekurapa ndechekubvisa zviratidzo kuburikidza nekuita dilating yepasi esophageal sphincter, nekubaya botulinum toxin, nebharumu, kana nekucheka tsandanyama dzesphincter.

Achalasia, iyo inonziwo cardiospasm kana megaesophagus, chirwere chekufamba kwesophagus, iyo inoratidzwa nekunzwa kusagadzikana paunomedza. Icho chirwere chisingawanzoitiki, chine huwandu hwe9-10 / 100 vanhu. Inogona kuoneka pazera ripi neripi, muvarume nevakadzi, ine peak in frequency pakati pemakore 000 ne30. Inowanzotanga, nenzira inonyengera, pakati pemakore e40 ne20 uye zvishoma nezvishoma inoshanduka mumwedzi yakawanda kana kunyange makore.

Kana ikamedzwa, chikafu chinoenda kudumbu kuburikidza nerhythmic esophageal muscle contractions inonzi peristalsis. Ipapo chikafu chinopinda mudumbu kuburikidza nekuvhurwa kwepazasi esophageal sphincter, inova mhete yetsandanyama inobata kumucheto kwegurokuro yakavharwa, kuitira kuti chikafu uye acid yemudumbu irege kuyerera ichikwira. mugurokuro. Paunomedza, iyi sphincter inozorora zvakajairika kuti chikafu chipfuure mudumbu.

Muachalasia, zviviri zvisina kunaka zvinowanzoonekwa: 

• kusavapo kwesophageal contraction, kana aperistalsis, inokonzerwa nekuderera kwetsinga mumadziro esophagus;
• uye kusavapo kana kusakwana kuvhurwa kwepazasi esophageal sphincter. 

Chiratidzo chikuru che achalasia kukanganisa kumedza. Izvi zvinotungamirira ku:

• dysphagia, ndiko kuti, kunzwa kwekuvharwa kwezvokudya pakumedza kana kuti inopfuura nepakati, iyo inowanikwa mu90% yevanhu vane achalasia;
• regurgitations, kunyanya panguva yehope, yezvokudya zvisina kudyiwa kana zvinwiwa, izvo zvinomira mugurokuro, zviripo mu70% yezviitiko;
• dzimwe nguva constricting marwadzo muchipfuva;
• kana varwere vakafemera chikafu mumapapu, zvinogona kukonzera kukosora, kutapukirwa kwechirwere chekufema, bronchiectasis ie dilation of the bronchi, kana inhalation pneumonia.

Zviratidzo izvi zvinogona kuramba kwemakore akawanda, zvichidzika uye zvisingaite, uye zvinoitika nekudya kwakasimba uye / kana zvinwiwa. Vanogona kuwedzera zvishoma nezvishoma uye zvichiita kuti uremerwe zvishoma kusvika pakati nepakati kana kusadya kwakakwana. Zvinetso zvekufema zvakajairika, zvinobata 20 kusvika 40% yevarwere.

Kuongororwa kwe achalasia kunobva pane:

• oesopastro-duodenal endoscopy exploration iyo inobvumira kutarisa jira resophagus;
• x-ray kuongororwa kwesophagus, umo murwere anodya barite, X-ray opaque musiyano wepakati, iyo inoita kuti zvikwanisike kuona esophagus yakanyungudutswa isingabudi zvakanaka;
• uye pakupedzisira esophageal manometry, iyo inoita kuti zvikwanisike, nekuda kwekuferefeta, kuyera madzvinyiriro pamwe chete nesophagus uye chiyero chekuzorodza chepasi esophageal sphincter. Muchiitiko che achalasia, manometry inocherechedza kusavapo kweguroguro contractions mukupindura kumedza kwemvura pamwe nekusavapo zvachose kana kusakwana kwekuzorora kwepasi esophageal sphincter.

Hapana kurapwa kunogona kugadzirisa pathophysiological alterations inokonzera achalasia.

Mishonga inorongwa inovavarira kudzoreredza zviratidzo nekudzikisa kudzvanywa kweyepasi esophageal sphincter uye nekuvandudza mafambiro esophageal zvirimo kusvika mudumbu kuburikidza ne gravity effect:

• jekiseni re botulinum toxin muzasi esophageal sphincter ne endoscopic nzira inobvumira kuti iburitswe. Kurapa uku, kunogona kuitwazve mwedzi mitanhatu kusvika kumiviri yega yega, kunonyanya kuratidzwa muvarwere vasina kusimba zvakanyanya vari panjodzi yekuvhiya;
• endoscopic dilation, kana pneumatic dilation, uchishandisa chibharumu chakaiswa pasogastric junction iyo yakafemerwa, uye inobvumira kutambanudza mhasuru uye kukurudzira kubuda kwegurokuro. Inoshanda munenge 80 kusvika 85% yematambudziko;
• Kuvhiya myotomy, inozivikanwa seHeller's, inosanganisira kucheka mhasuru dzepazasi esophageal sphincter nelaparoscopy, nzira yekuvhiya inobvumira kupinda mukati medumbu kuburikidza nediki diki. Kupindira uku, kunoshanda mune zvinopfuura 85% zvezviitiko, zvinowanzobatanidzwa nekugadzirwa kwevhavha pazinga re esogastric junction kuderedza dambudziko regastroesophageal reflux;
• iyo ichangoburwa peroral endoscopic myotomy (POEM) incision yakaitwa endoscopically. Iyi nzira, inoshanda mu90% yemakesi, inosanganisira kugadzira mugero mumadziro esophagus kuitira kuti usvike zvakananga kuzasi esophageal sphincter kuti ucheke. 

Mamwe marapirwo emishonga anogona kubatsira kuzorodza sphincter. Vane zvishoma kushanda asi vanogona kurebesa nguva pakati pemabharumu maviri dilations kana botulinum toxin jekiseni. Vanogona kutaridzirwa kune varwere vane contraindication yekuvhiya kana endoscopic dilation, uye kana chiitiko chekukundikana kwekurapa ne botulinum toxin. Izvi zvinosanganisira kunyanya:

• nitrate, yakadai se isosorbide dinitrate, kuiswa pasi perurimi musati madya; kuvandudzwa kwezviratidzo kunoonekwa mu53-87% yematambudziko;
• calcium channel blockers, yakadai senifedipine, inoiswawo pasi perurimi 30 kusvika 45 maminetsi vasati vadya. Kuvandudzwa kwedysphagia kunonzi mu53 kusvika ku90% yematambudziko.