Achalasia
Uhlolojikelele
I-achalasia yisimo sokuginya esithinta umgudu ohlanganisa umlomo nesisu, obizwa ngokuthi yi-esophagus. Izicubu ezonakeleyo zenza kube nzima emiphini ye-esophagus ukucindezela ukudla noketshezi esiswini. Ukudla kubuya kuqoqwe e-esophagus, ngezinye izikhathi kuhlasimula futhi kubuyele emlonyeni. Lokhu kudla okuhlasimuliwe kungaba nomunyu olukhulu. I-Achalasia yisimo esingavamile. Abanye abantu bayikhohlisa nge-gastroesophageal reflux disease (GERD). Kodwa-ke, ku-achalasia, ukudla kuvela e-esophagus. Ku-GERD, izinto zivela esiswini. Ayikho imithi yokwelapha i-achalasia. Uma i-esophagus yonakele, imisipha ayikwazi ukusebenza kahle futhi. Kodwa izimpawu zingaphathwa ngokuvamile nge-endoscopy, ukwelashwa okungenayo inkinga noma ukuhlinzwa.
Izimpawu
Izimpawu ze-Achalasia ngokuvamile zivela kancane kancane futhi zibe zimbi ngokuhamba kwesikhathi. Izimpawu zingafaka:
- Ukukhuluphala kokugwinya, okuthiwa yi-dysphagia, okungase kuzwakale sengathi ukudla noma isiphuzo kunamathele entanyeni.
- Ukudla okugwinyiwe noma umaluleko ubuyela emuva entanyeni.
- Ukushisa kwenhliziyo.
- Ukukhipha umoya.
- Ubuhlungu obusuka ehlombe obuza futhi buyaphela.
- Ukukhokha ebusuku.
- I-Pneumonia evela ekungeneni kokudla emaphashini.
- Ukulahlekelwa isisindo.
- Ukugabha.
Izimbangela
Imbangela eqondile ye-achalasia ayiqondakali kahle. Abacwaningi bacabanga ukuthi ingase ibangelwe ukulahleka kwamaselula ezinzwa esibindini. Kunezinkolelo mayelana nokuthi yini ebangela lokhu, kodwa ukutheleleka yi-viral noma izimpendulo ezizimele zingaba yizimbangela. Ngokungaqondakali, i-achalasia ingabangelwa yi-genetic disorder ezuzwe noma ukutheleleka.
Izici eziyingozi
Izimbangela ezingozi ze-achalasia zifaka phakathi:
- Ubudala. Nakuba i-achalasia ingathinta abantu bazo zonke izigaba zobudala, ivame kakhulu kubantu abaneminyaka ephakathi kuka-25 no-60.
- Izimo ezithile zezokwelapha. Ubungozi be-achalasia bukhulu kubantu abanezilonda ze-allergic, ukungasebenzi kahle kwe-adrenal noma i-Allgrove syndrome, isimo esingavamile se-genetic esidluliselwa ngokulandelana kwe-autosomal recessive.
Ukuxilongwa
I-Achalasia ingase ihlukaniswe kalula noma ingalungiswa ngokungalungile ngoba inezingxaki ezifanayo nalezo zezinye izifo zokugaya. Ukuhlola i-achalasia, ochwepheshe bezempilo cishe bayokuncoma: Ukwelula esophageal. Lo viwo uqapha ukucindezela kwemisipha esibindini ngesikhathi sokugwinya. Uphinde uqapha ukuthi i-sphincter esophageal ephansi ivula kangcono kangakanani ngesikhathi sokugwinya. Lo viwo usiza kakhulu lapho unquma uhlobo oluthile lwezimo zokugwinya onayo. Izithombe ze-X zesigxobo sokuqala sokuhlanza. Izithombe ze-X zithathwa ngemuva kokuphuza ulwetshe oluthile oluthiwa yi-barium. I-barium ihlanganisa ukugqoka kwangaphakathi kwesigxobo sokuhlanza futhi igcwalisa izitho zokugaya. Lokhu kugqoka kuvumela ochwepheshe bezempilo ukubona isithunzi se-esophagus, isisu kanye nezinso eziphezulu. Ngaphezu kokuphuza leli lwetshe, ukugwinya iphilisi le-barium kungasiza ukukhombisa ukuvimba esibindini. I-endoscopy ephezulu. I-endoscopy ephezulu isebenzisa ikhamera encane ekugcineni kompompi oluthambile ukuhlola ngeso lesibonakaliso isimiso sokuqala sokuhlanza. I-Endoscopy ingasetshenziswa ukuthola ukuvimba okulinganiselwe kwesibindini. I-Endoscopy ingasetshenziswa futhi ukuqoqa isampula yethishu, ebizwa ngokuthi yi-biopsy, ukuhlolwa kwezinkinga zokubuyela emuva njenge-Barrett esophagus. Ubuchwepheshe be-functional luminal imaging probe (FLIP). I-FLIP iyindlela entsha engasiza ekuqinisekiseni ukuxilongwa kwe-achalasia uma ezinye izivivinyo zinganelisi. Ukunakekelwa eMayo Clinic Iqembu lethu lochwepheshe beMayo Clinic elinakekelayo lingakusiza ngezinkinga zakho zempilo ezihlobene ne-achalasia Qala Lapha
Ukwelashwa
Ukwelapha i-Achalasia kugxile ekukhululeni noma ekwandiseni isinqe se-esophageal esisezantsi ukuze ukudla noketshezi kuhambe kalula nge-digestive tract. Ukwelapha okuthile kuncike ebudaleni bakho, esimweni sempilo yakho, nasobunzimeni be-achalasia. Izindlela ezingahlali ekuhlinzweni zihlanganisa:
- Ukukhululwa komoya (Pneumatic dilation). Ngalesi senzo esingapheli esibhedlela, ibhaluni ifakwa ebukhoneni besinqe se-esophageal bese iphephethelwa ukuze ikhululise ukuvulwa. Ukukhululwa komoya kungase kudingeke kwenziwe kabusha uma isinqe se-esophageal singavuli. Cishe ingxenye yesithathu yabantu abaphathwe ngokukhululwa kwebhaluni badinga ukwelashwa kabusha phakathi kweminyaka emihlanu. Lesi senzo sidinga ukulaliswa.
- I-OnabotulinumtoxinA (Botox). Lo mthambisi wemisipha ungafakwa ngqo esinqeni se-esophageal ngenesi ngesikhathi se-endoscopy. Ukufakwa kungase kudingeke kwenziwe kabusha, futhi ukufakwa kabusha kungenza kube nzima ukwenza ukuhlinzwa kamuva uma kudingeka.
I-Botox ivame ukunconywa kuphela kubantu abangakwazi ukwenza ukukhululwa komoya noma ukuhlinzwa ngenxa yobudala noma impilo yonke. Ukufakwa kwe-Botox ngokuvamile akugcini izinyanga ezingaphezu kweziyisithupha. Ukuthuthuka okukhulu ekuqaleni kwe-Botox kungasiza ekuqinisekiseni ukuxilongwa kwe-achalasia.
- Imithi. Udokotela wakho angase ancome imithambisi yemisipha efana ne-nitroglycerin (Nitrostat) noma i-nifedipine (Procardia) ngaphambi kokudla. Le mithi inomphumela omncane wokwelapha nemiphumela emibi eqinile. Imithi ngokuvamile icatshelwa kuphela uma ungumuntu ongafaneleki ukwenza ukukhululwa komoya noma ukuhlinzwa futhi i-Botox ayisizanga. Lolu hlobo lokwelapha aluvamile ukunconywa.
I-OnabotulinumtoxinA (Botox). Lo mthambisi wemisipha ungafakwa ngqo esinqeni se-esophageal ngenesi ngesikhathi se-endoscopy. Ukufakwa kungase kudingeke kwenziwe kabusha, futhi ukufakwa kabusha kungenza kube nzima ukwenza ukuhlinzwa kamuva uma kudingeka.
I-Botox ivame ukunconywa kuphela kubantu abangakwazi ukwenza ukukhululwa komoya noma ukuhlinzwa ngenxa yobudala noma impilo yonke. Ukufakwa kwe-Botox ngokuvamile akugcini izinyanga ezingaphezu kweziyisithupha. Ukuthuthuka okukhulu ekuqaleni kwe-Botox kungasiza ekuqinisekiseni ukuxilongwa kwe-achalasia.
Izindlela zokuhlinzwa zokwelapha i-achalasia zihlanganisa:
- I-Heller myotomy. I-Heller myotomy ihilela ukusika umsipha ekugcineni kwesinqe se-esophageal. Lokhu kuvumela ukudla ukudlula kalula esiswini. Le nqubo ingenziwa ngendlela encane yokungena ebizwa ngokuthi i-laparoscopic Heller myotomy. Abanye abantu abane-Heller myotomy bangase kamuva bathuthukise isifo se-gastroesophageal reflux (GERD).
Ukuze kugwenywe izinkinga zesikhathi esizayo ne-GERD, udokotela angenza inqubo ebizwa ngokuthi i-fundoplication ngesikhathi esifanayo ne-Heller myotomy. Ku-fundoplication, udokotela uqengqeleka phezulu kwesisu ngaphezulu kwe-esophagus ephansi ukuze adale i-valve yokumelana nokubuyela emuva, ukuvimbela i-acid ukuba ingabuyele e-esophagus. I-Fundoplication ngokuvamile yenziwa ngenqubo encane yokungena, ebizwa nangokuthi inqubo ye-laparoscopic.
- I-Peroral endoscopic myotomy (POEM). Ekuqaleni kwe-POEM, udokotela usebenzisa i-endoscope efakwe ngomlomo bese eya phansi e-throat ukuze enze isiko ekugcineni kwesinqe se-esophageal. Khona-ke, njengoba kunjalo ku-Heller myotomy, udokotela usika umsipha ekugcineni kwesinqe se-esophageal.
I-POEM ingase ihlanganiswe noma ilandelwe yi-fundoplication kamuva ukuze kusize ekuvimbeleni i-GERD. Abanye abantu abane-POEM futhi bathuthukise i-GERD ngemuva kwenqubo baphathwa ngemithi yansuku zonke ethathwa ngomlomo.
I-Heller myotomy. I-Heller myotomy ihilela ukusuka umsipha ekugcineni kwesinqe se-esophageal. Lokhu kuvumela ukudla ukudlula kalula esiswini. Le nqubo ingenziwa ngendlela encane yokungena ebizwa ngokuthi i-laparoscopic Heller myotomy. Abanye abantu abane-Heller myotomy bangase kamuva bathuthukise isifo se-gastroesophageal reflux (GERD).
Ukuze kugwenywe izinkinga zesikhathi esizayo ne-GERD, udokotela angenza inqubo ebizwa ngokuthi i-fundoplication ngesikhathi esifanayo ne-Heller myotomy. Ku-fundoplication, udokotela uqengqeleka phezulu kwesisu ngaphezulu kwe-esophagus ephansi ukuze adale i-valve yokumelana nokubuyela emuva, ukuvimbela i-acid ukuba ingabuyele e-esophagus. I-Fundoplication ngokuvamile yenziwa ngenqubo encane yokungena, ebizwa nangokuthi inqubo ye-laparoscopic.
I-Peroral endoscopic myotomy (POEM). Ekuqaleni kwe-POEM, udokotela usebenzisa i-endoscope efakwe ngomlomo bese eya phansi e-throat ukuze enze isiko ekugcineni kwesinqe se-esophageal. Khona-ke, njengoba kunjalo ku-Heller myotomy, udokotela usika umsipha ekugcineni kwesinqe se-esophageal.
I-POEM ingase ihlanganiswe noma ilandelwe yi-fundoplication kamuva ukuze kusize ekuvimbeleni i-GERD. Abanye abantu abane-POEM futhi bathuthukise i-GERD ngemuva kwenqubo baphathwa ngemithi yansuku zonke ethathwa ngomlomo.
Umshwana wokuzihlangula: I-August iyinkundla yolwazi lwezempilo futhi izimpendulo zayo azihlanganisi iseluleko sezokwelapha. Njalo thintana nochwepheshe bezokwelapha onelayisensi eduze nawe ngaphambi kokwenza noma yiluphi ushintsho.