.png){kind=icon}
返回
Achalasia
.png){kind=icon}
PRE
AI
DOI：10.1038/s41572-022-00356-8.png)
.png){kind=icon}
原文求助.png){kind=icon}
分享.png){kind=icon}
收藏
摘要
En 中文
Achalasia is a disorder of the oesophageal smooth muscle characterized by impaired lower oesophageal sphincter relaxation and absent or spastic oesophageal body contractions. This Primer reviews the epidemiology, pathophysiology, diagnosis and management of achalasia, as well as patient quality of life and areas for further research. Achalasia is a rare disorder of the oesophageal smooth muscle characterized by impaired relaxation of the lower oesophageal sphincter (LES) and absent or spastic contractions in the oesophageal body. The key pathophysiological mechanism is loss of inhibitory nerve function that probably results from an autoimmune attack targeting oesophageal myenteric nerves through cell-mediated and, possibly, antibody-mediated mechanisms. Achalasia incidence and prevalence increase with age, but the disorder can affect all ages and both sexes. Cardinal symptoms consist of dysphagia, regurgitation, chest pain and weight loss. Several years can pass between symptom onset and an achalasia diagnosis. Evaluation starts with endoscopy to rule out structural causes, followed by high-resolution manometry and/or barium radiography. Functional lumen imaging probe can provide complementary evidence. Achalasia subtypes have management and prognostic implications. Although symptom questionnaires are not useful for diagnosis, the Eckardt score is a simple symptom scoring scale that helps to quantify symptom response to therapy. Oral pharmacotherapy is not particularly effective. Botulinum toxin injection into the LES can temporize symptoms and function as a bridge to definitive therapy. Pneumatic dilation, per-oral endoscopic myotomy and laparoscopic Heller myotomy can provide durable symptom benefit. End-stage achalasia with a dilated, non-functioning oesophagus may require oesophagectomy or enteral feeding into the stomach. Long-term complications can, rarely, include oesophageal cancer, but surveillance recommendations have not been established.
Keyword:
PERORAL ENDOSCOPIC MYOTOMY
ESOPHAGEAL MOTILITY DISORDERS
LAPAROSCOPIC HELLER MYOTOMY
HIGH-RESOLUTION MANOMETRY
QUALITY-OF-LIFE
TIMED BARIUM ESOPHAGOGRAM
BOTULINUM TOXIN INJECTION
LUMEN IMAGING PROBE
PNEUMATIC DILATION
NITRIC-OXIDE
期刊
N
IF:
60.6
论文数:
648
被引数:
3.8W
机构
引用论文
Inspiratory and skeletal muscle strength and endurance and diaphragmatic activation in patients with chronic airflow limitation..png)
Thorax
OAAI
ThoraxIF0
OAAI分享收藏Silver(i) ions modulate the stability of DNA duplexes containing cytosine, methylcytosine and hydroxymethylcytosine at different salt concentrationsRSC AdvancesOAAI
RSC AdvancesIF0
OAAI分享收藏分享收藏Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodiesNEUROLOGY
NEUROLOGYIF8.5
PREAI
分享收藏
查看更多内容