I-Achalasia yisifo esenzeka lapho ukufinyela kwesisu kungabikho noma kungavamile, i-sphincter engezansi ye-esophageal ayiphumuli ngokujwayelekile, futhi ingcindezi yokuphumula ye-esophageal sphincter iyanda. Inhloso yokwelashwa ukunciphisa izimpawu ngokunciphisa i-sphincter engezansi, ngokujova i-toxin ye-botulinum, ngebhaluni, noma ngokusika imicu yemisipha ye-sphincter.

I-Achalasia, ebizwa nangokuthi i-cardiospasm noma i-megaesophagus, ukuphazamiseka kokuhamba kwesifo, okubonakala ngokungazizwa kahle lapho ugwinya. Lesi yisifo esingajwayelekile, esikhona kubantu abangu-9-10 / 100. Ingabonakala kunoma yisiphi isikhathi, kokubili kwabesilisa nakwabesifazane, ngesilinganiso esiphakeme semvamisa phakathi kweminyaka engu-000 nengama-30. Imvamisa iqala, ngendlela ecashile, ephakathi kweminyaka engama-40 nengama-20 futhi iguquka kancane kancane ezinyangeni ezimbalwa noma ngisho neminyaka.

Uma kugwinyiwe, ukudla kudlulela esiswini ngokuqina kwezicubu zomzimba okubizwa ngokuthi yi-peristalsis. Bese kuthi ukudla kungene esiswini ngokuvulwa kwe-esophageal sphincter engezansi, okuyindandatho yemisipha ebambe ukuphela kwangaphansi komqala kuvaliwe, ukuze ukudla ne-asidi yesisu kungabuyeli emuva. singene emphinjeni. Uma ugwinya, le sphincter ikhululeka ngokwejwayelekile ukuvumela ukudla kudlule kusesiswini.

Ku-achalasia, ukungajwayelekile okubili kuvame ukuvela: 

• ukungabi bikho kokuqunjelwa kokuqunjelwa kokuqunjelwa, noma isibulalawo somzimba, okubangelwa ukwehla kwezinzwa emdongeni wesisu;
• nokungabikho noma ukuvulwa okungaphelele kwe-sphincter engezansi yokucinana. 

Uphawu oluyinhloko lwe-achalasia yizinkinga zokugwinya. Lokhu kuholela ku:

• i-dysphagia, okungukuthi, umuzwa wokuvinjelwa kokudla lapho ugwinya noma njengoba udlula endaweni yomzimba, ekhona kubantu abangama-90% abane-achalasia;
• ukuphindwaphindwa, ikakhulukazi ngesikhathi sokulala, kokudla okungadliwe noma oketshezi, okuma endaweni yomlomo, kutholakala ezimweni ezingama-70%;
• kwesinye isikhathi kunciphisa ubuhlungu besifuba;
• uma iziguli zihogela ukudla emaphashini, kungaholela ekukhwehleleni, ukutheleleka komgudu wokuphefumula, i-bronchiectasis okungukuthi ukunwebeka kwe-bronchi, noma i-pneumonia yokuphefumula.

Lezi zimpawu zingaqhubeka iminyaka eminingi, ngezikhathi ezithile nangaphandle kwamandla, futhi zivele ngokudla okuqinile kanye / noma uketshezi. Zingakhula kancane kancane futhi ziholele ekunciphiseni isisindo okuncane noma okulingene noma ngisho nokungondleki kahle. Izinkinga zokuphefumula zivamile, zithinta iziguli ezingama-20 kuye ku-40%.

Ukuxilongwa kwe-achalasia kusekelwe ku:

• ukuhlola kwe-oesopastro-duodenal endoscopy okuvumela ukubheka ulwelwesi lwe-esophagus;
• ukuhlolwa kwe-x-ray kwesimila, lapho isiguli simunca khona i-barite, i-X-ray opaque umehluko medium, eyenza sikwazi ukubona ngeso lengqondo i-esophagus eseluliwe engaphumi kahle;
• futhi ekugcineni i-manometry esophageal, eyenza ukuthi kwenzeke, ngenxa yocwaningo, ukukala izingcindezi ezihambisana nommango kanye nezinga lokuphumula kwe-sphincter engezansi yesophageal. Uma kwenzeka i-achalasia, i-manometry iphawula ukungabi khona kwezingcindezi zokuphefumula ngenxa yokugwinywa kwamanzi kanye nokungabikho okuphelele noma okungaphelele kokuphumula kwe-sphincter engezansi.

Akukho ukwelashwa okungalungisa ukuguqulwa kwe-pathophysiological okubhekele i-achalasia.

Izindlela zokwelashwa ezihlongozwayo zihlose ukukhulula izimpawu ngokunciphisa ingcindezi ye-sphincter engezansi yokuqinisa isisu nokwenza ngcono ukudluliswa kokuqukethwe kokuqunjelwa esiswini ngomphumela wamandla adonsela phansi:

• umjovo we-botulinum toxin ku-esophageal sphincter ephansi ngomzila we-endoscopic uyakuvumela ukuthi kukhishwe. Le ndlela yokwelashwa, evuselelwa njalo ezinyangeni eziyisithupha kuya kweziyishumi nambili, ikhonjiswa ikakhulu ezigulini ezibuthakathaka kakhulu ezisengozini enkulu yokuhlinzwa;
• i-endoscopic dilation, noma i-pneumatic dilation, kusetshenziswa ibhaluni elibekwe enhlanganweni ye-esogastric egcwele umoya, futhi evumela ukwelula imisipha futhi ikhuthaze ukukhishwa komphimbo. Isebenza cishe emacaleni angama-80 kuya kwangu-85%;
• i-myotomy yokuhlinza, eyaziwa ngokuthi yi-Heller's, iqukethe ukusika imicu yemisipha ye-sphincter engezansi esophageal nge-laparoscopy, inqubo yokuhlinza evumela ukufinyelela ngaphakathi kwesisu ngokusebenzisa ukusikeka okuncane. Lokhu kungenelela, okusebenza ngaphezu kwamacala angama-85%, ngokuvamile kuhlotshaniswa nokwakhiwa kwe-valve ezingeni le-junction ye-esogastric ukunciphisa ubungozi be-reflux yegastroesophageal;
• i-myotomy ye-endoscopic yakamuva ye-peroscopic (i-POEM) ingumbhoshongo owenziwe nge-endoscopically. Le ndlela, esebenza ngamacala angama-90%, iqukethe ukudala umhubhe odongeni lomhosha ukuze ufinyelele ngqo kwi-sphincter engezansi yokuwunquma. 

Ukwelashwa okuthile kwemithi kungasiza ukukhulula i-sphincter. Banokusebenza okulinganiselwe kepha bangeza isikhathi phakathi kokuhlulwa kwamabhaluni amabili noma imijovo ye-botulinum toxin. Zingacatshangelwa ezigulini ezinokuphikisana nokuhlinzwa noma i-endoscopic dilation, futhi uma kwenzeka ukwehluleka ukwelashwa nge-botulinum toxin. Lokhu kufaka ikakhulukazi:

• ama-nitrate, afana ne-isosorbide dinitrate, okufanele abekwe ngaphansi kolimi ngaphambi kokudla; ukuthuthukiswa kwezimpawu kubonakala kuma-53-87% wamacala;
• ama-calcium channel blocker, njenge-nifedipine, nawo abekwa ngaphansi kolimi imizuzu engama-30 kuya kwengama-45 ngaphambi kokudla. Ukuthuthuka kwe-dysphagia kubikwa kuma-53 kuye kuma-90% wamacala.