Achalasia

ʻO ka mālama ʻana i ka achalasia ke kau nui ma ka hoʻomaha a i ʻole ka hoʻolōʻihi ʻana i ka sphincter esophageal haʻahaʻa, i hiki ai i ka meaʻai a me ka wai ke neʻe maʻalahi ma o ka ʻōnaehana digestive.

Kaukaʻi ka mālama kūikawā ma kāu mau makahiki, kūlana olakino a me ka nui o ka achalasia.

ʻO nā koho ʻaʻole ʻoki kino e komo pū me:

• Pneumatic dilation. I loko o kēia kaʻina hana ma waho, hoʻokomo ʻia kahi pulupulu i loko o ka waenakonu o ka sphincter esophageal a hoʻonui ʻia e hoʻonui i ka puka. Pono paha e hana hou i ka pneumatic dilation inā ʻaʻole e noho wehe ka sphincter esophageal. Aneane hoʻokahi hapakolu o nā kānaka i mālama ʻia me ka dilation pulupulu e pono ai ka mālama hou i loko o ʻelima mau makahiki. Pono kēia kaʻina hana i ka sedation.
• OnabotulinumtoxinA (Botox). Hiki ke hoʻokomo pololei ʻia kēia mea hoʻomaha iʻiʻo i loko o ka sphincter esophageal me kahi nila i ka wā o ka endoscopy. Pono paha e hana hou i nā inikini, a hiki i nā inikini hou ke hana i ka paʻakikī o ka hana ʻoki kino ma hope inā pono.

Hoʻomaopopo ʻia ka Botox ma ke ʻano maʻamau wale nō no nā kānaka ʻaʻole hiki ke loaʻa i ka pneumatic dilation a i ʻole ka ʻoki kino ma muli o ka makahiki a i ʻole ke olakino holoʻokoʻa. ʻAʻole mau ka lōʻihi o nā inikini Botox ma mua o ʻeono mau mahina. Hiki i ka hoʻomaikaʻi ikaika mai ka inikini o Botox ke kōkua i ka hōʻoia ʻana i ka hōʻailona o ka achalasia.

• Lāʻau lapaʻau. Hiki i kāu kauka ke manaʻo i nā mea hoʻomaha iʻiʻo e like me ka nitroglycerin (Nitrostat) a i ʻole ka nifedipine (Procardia) ma mua o ka ʻai ʻana. Loaʻa i kēia mau lāʻau lapaʻau ka hopena mālama palena a me nā hopena ʻaoʻao koʻikoʻi. Manaʻo ʻia nā lāʻau lapaʻau ma ke ʻano maʻamau wale nō inā ʻaʻole ʻoe he moho no ka pneumatic dilation a i ʻole ka ʻoki kino a ʻaʻole i kōkua ka Botox. Loaʻa ʻole kēia ʻano o ka mālama ʻana.

OnabotulinumtoxinA (Botox). Hiki ke hoʻokomo pololei ʻia kēia mea hoʻomaha iʻiʻo i loko o ka sphincter esophageal me kahi nila i ka wā o ka endoscopy. Pono paha e hana hou i nā inikini, a hiki i nā inikini hou ke hana i ka paʻakikī o ka hana ʻoki kino ma hope inā pono.

Hoʻomaopopo ʻia ka Botox ma ke ʻano maʻamau wale nō no nā kānaka ʻaʻole hiki ke loaʻa i ka pneumatic dilation a i ʻole ka ʻoki kino ma muli o ka makahiki a i ʻole ke olakino holoʻokoʻa. ʻAʻole mau ka lōʻihi o nā inikini Botox ma mua o ʻeono mau mahina. Hiki i ka hoʻomaikaʻi ikaika mai ka inikini o Botox ke kōkua i ka hōʻoia ʻana i ka hōʻailona o ka achalasia.

ʻO nā koho ʻoki kino no ka mālama ʻana i ka achalasia e komo pū me:

• Heller myotomy. Hoʻopili ka Heller myotomy i ka ʻoki ʻana i ka iʻiʻo ma ka hopena haʻahaʻa o ka sphincter esophageal. Hāʻawi kēia i ka meaʻai e hele maʻalahi i loko o ka ʻōpū. Hiki ke hana ʻia ke kaʻina hana me kahi ʻenehana liʻiliʻi i kapa ʻia ʻo ka laparoscopic Heller myotomy. Hiki i kekahi poʻe i loaʻa ka Heller myotomy ke loaʻa ma hope aku i ka maʻi gastroesophageal reflux (GERD).

No ka pale ʻana i nā pilikia ma hope me ka GERD, hiki i ke kauka ʻoki ke hana i kahi kaʻina hana i ʻike ʻia ʻo fundoplication i ka manawa like me ka Heller myotomy. I loko o ka fundoplication, e kāʻei ka kauka ʻoki i ka piko o ka ʻōpū a puni ka esophagus haʻahaʻa e hana i kahi valve anti-reflux, e pale ana i ka waikawa mai ka hoʻi ʻana i loko o ka esophagus. Hana ʻia ka fundoplication ma ke ʻano maʻamau me kahi kaʻina hana liʻiliʻi, i kapa ʻia hoʻi he kaʻina hana laparoscopic.

• Peroral endoscopic myotomy (POEM). I loko o ke kaʻina hana POEM, hoʻohana ka kauka ʻoki i kahi endoscope i hoʻokomo ʻia ma o ka waha a i lalo i ka ʻāʻī e hana i kahi ʻoki i loko o ka papa o loko o ka esophagus. A laila, e like me ka Heller myotomy, e ʻoki ka kauka ʻoki i ka iʻiʻo ma ka hopena haʻahaʻa o ka sphincter esophageal.

Hiki ke hui pū ʻia ka POEM a i ʻole ma hope o ka fundoplication e kōkua i ka pale ʻana i ka GERD. Mālama ʻia kekahi mau mea maʻi i loaʻa ka POEM a loaʻa ka GERD ma hope o ke kaʻina hana me ka lāʻau lapaʻau i lawe ʻia i kēlā me kēia lā ma ka waha.

Heller myotomy. Hoʻopili ka Heller myotomy i ka ʻoki ʻana i ka iʻiʻo ma ka hopena haʻahaʻa o ka sphincter esophageal. Hāʻawi kēia i ka meaʻai e hele maʻalahi i loko o ka ʻōpū. Hiki ke hana ʻia ke kaʻina hana me kahi ʻenehana liʻiliʻi i kapa ʻia ʻo ka laparoscopic Heller myotomy. Hiki i kekahi poʻe i loaʻa ka Heller myotomy ke loaʻa ma hope aku i ka maʻi gastroesophageal reflux (GERD).

No ka pale ʻana i nā pilikia ma hope me ka GERD, hiki i ke kauka ʻoki ke hana i kahi kaʻina hana i ʻike ʻia ʻo fundoplication i ka manawa like me ka Heller myotomy. I loko o ka fundoplication, e kāʻei ka kauka ʻoki i ka piko o ka ʻōpū a puni ka esophagus haʻahaʻa e hana i kahi valve anti-reflux, e pale ana i ka waikawa mai ka hoʻi ʻana i loko o ka esophagus. Hana ʻia ka fundoplication ma ke ʻano maʻamau me kahi kaʻina hana liʻiliʻi, i kapa ʻia hoʻi he kaʻina hana laparoscopic.

Peroral endoscopic myotomy (POEM). I loko o ke kaʻina hana POEM, hoʻohana ka kauka ʻoki i kahi endoscope i hoʻokomo ʻia ma o ka waha a i lalo i ka ʻāʻī e hana i kahi ʻoki i loko o ka papa o loko o ka esophagus. A laila, e like me ka Heller myotomy, e ʻoki ka kauka ʻoki i ka iʻiʻo ma ka hopena haʻahaʻa o ka sphincter esophageal.

Hiki ke hui pū ʻia ka POEM a i ʻole ma hope o ka fundoplication e kōkua i ka pale ʻana i ka GERD. Mālama ʻia kekahi mau mea maʻi i loaʻa ka POEM a loaʻa ka GERD ma hope o ke kaʻina hana me ka lāʻau lapaʻau i lawe ʻia i kēlā me kēia lā ma ka waha.