Achalazja
Zapobieganie i profilaktyka
Achalazja to rzadkie zaburzenie motoryki przełyku, charakteryzujące się nieprawidłowym rozluźnianiem dolnego zwieracza przełyku oraz brakiem perystaltyki w dystalnej części przełyku. Etiologia pozostaje nieznana, co uniemożliwia profilaktykę choroby. Leczenie obejmuje metody takie jak rozszerzanie pneumatyczne, iniekcje toksyny botulinowej, zabiegi chirurgiczne oraz przezoralną endoskopową miotomię (POEM), która jest wysoce skuteczna i małoinwazyjna. Terapia przełykania z udziałem logopedy oraz modyfikacje diety (np. spożywanie pokarmów o miękkiej konsystencji, picie dużej ilości wody podczas posiłków) wspomagają funkcję przełyku. W skrajnych przypadkach konieczne może być żywienie alternatywne przez zgłębnik nosowy lub rurkę.
- Profilaktyka achalazji – wprowadzenie
- Zapobieganie powikłaniom achalazji
- Modyfikacje dietetyczne i techniki ułatwiające przełykanie
- Terapia przełykania
- Zaawansowane techniki odżywiania
- Profilaktyka i nadzór w kierunku raka przełyku
- Zapobieganie powikłaniom związanym z refluksem
- Długoterminowe postępowanie w achalazji
Profilaktyka achalazji – wprowadzenie
Achalazia jest rzadkim zaburzeniem motoryki przełyku, charakteryzującym się nieprawidłowym rozluźnianiem dolnego zwieracza przełyku i brakiem perystaltyki w dystalnej części przełyku. Ze względu na to, że etiologia achalazji pozostaje w dużej mierze nieznana, nie istnieją specyficzne metody, które mogłyby zapobiec rozwojowi tej choroby.1234 Jednak odpowiednie leczenie i monitorowanie stanu pacjenta mogą pomóc w zapobieganiu powikłaniom związanym z achalazją.56
Zapobieganie powikłaniom achalazji
Choć nie można zapobiec samej achalazji, odpowiednie postępowanie terapeutyczne oraz regularny nadzór medyczny mogą znacząco zmniejszyć ryzyko wystąpienia powikłań długoterminowych.7 Należy pamiętać, że nawet po skutecznym leczeniu, zdolność przełykania może z czasem ulegać pogorszeniu, co wymaga stałego monitorowania.8
Modyfikacje dietetyczne i techniki ułatwiające przełykanie
- Spożywanie posiłków powoli i dokładne przeżuwanie pokarmów
- Picie dużej ilości wody podczas posiłków dla ułatwienia przełykania
- Unikanie spożywania pokarmów tuż przed snem
- Wybieranie pokarmów o miękkiej konsystencji lub przygotowanych w formie purée
- Utrzymywanie regularnego rytmu posiłków bez ich pomijania
- Dbanie o odpowiednie nawodnienie organizmu
Terapia przełykania
Terapia przełykania to technika opracowana z pomocą logopedy, która może pomóc pacjentom w lepszym przełykaniu i jedzeniu poprzez wdrożenie określonych praktyk wzmacniających mięśnie wewnętrzne.11 Odpowiednie ćwiczenia przełykania dla mięśni mogą poprawić napięcie i siłę dolnego zwieracza przełyku.12
Zaawansowane techniki odżywiania
W skrajnych przypadkach achalazji, gdy trudności z przełykaniem są znaczne, może być konieczne zastosowanie alternatywnych metod odżywiania, takich jak karmienie przez zgłębnik nosowy lub żywienie przez rurkę.13
Profilaktyka i nadzór w kierunku raka przełyku
Achalazia jest znanym czynnikiem ryzyka rozwoju raka przełyku.14 Pacjenci powinni być poinformowani o zwiększonym ryzyku wystąpienia nowotworu, szczególnie po 10 latach trwania choroby, nawet jeśli są poddawani leczeniu.15
Czynniki zwiększające ryzyko raka przełyku u pacjentów z achalazją
Leczenie achalazji metodami, które zwiększają ryzyko refluksu, takimi jak iniekcje toksyny botulinowej, rozszerzanie pneumatyczne oraz przezoralną endoskopową miotomię (POEM), należy rozważać jako dodatkowy czynnik ryzyka rozwoju gruczolakoraka przełyku.16 POEM, mimo że jest wysoce skuteczną, małoinwazyjną procedurą endoskopową w leczeniu achalazji, która nie wymaga wykonywania nacięć chirurgicznych w jamie brzusznej, może wiązać się z tym ryzykiem.17
Strategie nadzoru onkologicznego
Nadzór endoskopowy może prowadzić do wczesnego rozpoznania raka lub późnych powikłań i powinien być rozważony po 10-15 latach trwania choroby.18 Zaleca się szczególnie pacjentom z ponad 10-letnim wywiadem choroby, zwłaszcza jeśli współistnieją inne czynniki ryzyka.19
Regularne badania kontrolne w postaci czasowego badania z barytem powinny być wykonywane co rok lub dwa, ponieważ niektórzy pacjenci mogą wymagać rozszerzania pneumatycznego, powtórnej miotomii, a nawet ezofagektomii po wielu latach.20 Niektórzy lekarze zalecają również badanie pH i endoskopię w celu wykrycia uszkodzeń spowodowanych refluksem, które nieleczone mogą prowadzić do zwężenia lub raka przełyku.21
Zapobieganie powikłaniom związanym z refluksem
Po zabiegach leczenia achalazji, szczególnie po procedurach chirurgicznych, pacjenci mogą być narażeni na zwiększone ryzyko choroby refluksowej przełyku. Inhibitory pompy protonowej mogą pomóc w zapobieganiu uszkodzeniom spowodowanym refluksem po operacji poprzez hamowanie wydzielania kwasu żołądkowego.22
Długoterminowe postępowanie w achalazji
Obecnie nie istnieje znane lekarstwo na achalazję.2324 Jednakże kilka metod leczenia może zapewnić dobrą do doskonałej ulgę od objawów przez wiele lat. Gdy leczenie wymaga powtórzenia, może być równie skuteczne jak początkowe interwencje.25
Dostępne opcje terapeutyczne obejmują rozszerzanie pneumatyczne, iniekcje toksyny botulinowej, zabiegi chirurgiczne lub leczenie farmakologiczne.26 Procedura POEM (przezoralną endoskopową miotomię) okazała się wysoce skuteczna w leczeniu achalazji, nie wymagając przy tym wykonywania chirurgicznych nacięć w jamie brzusznej.27
Systematyczne i kompleksowe podejście do leczenia achalazji może znacząco poprawić jakość życia pacjenta i zmniejszyć ryzyko powikłań, w tym rozwoju nowotworu przełyku.
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Materiały źródłowe
- #1 Achalasia Guide: Causes, Symptoms and Treatment Optionshttps://www.drugs.com/health-guide/achalasia.html
Since the cause of achalasia is unknown, there is no way to prevent it.
- #2 Achalasia – Harvard Healthhttps://www.health.harvard.edu/a_to_z/achalasia-a-to-z
Since the cause of achalasia is unknown, there is no way to prevent it. […] There is no known cure for achalasia. But several treatments can provide good to excellent relief from symptoms for a number of years. When treatment needs to be repeated, it can be as successful as initial treatment.
- #3 Achalasia | Cedars-Sinaihttps://www.cedars-sinai.org/health-library/diseases-and-conditions/a/achalasia.html
Researchers dont know how to prevent achalasia. […] Treatment can help prevent long-term complications, such as:
- #4 UC San Diego Health Health Library | San Diego Hospital, Healthcarehttps://myhealth.ucsd.edu/conditions/Heart/134,167
Researchers dont know how to prevent achalasia. […] Treatment can help prevent long-term complications, such as: […] There is no known cure. But treatments can manage your symptoms. Treatment may include pneumatic dilation, botulinum toxin injections, surgery, or medicines.
- #5 Achalasia Information | Mount Sinai – New Yorkhttps://www.mountsinai.org/health-library/diseases-conditions/achalasia
Many of the causes of achalasia cannot be prevented. However, treatment may help to prevent complications.
- #6 Chagas diseasehttps://adamcertificationdemo.adam.com/content.aspx?productid=141&pid=1&gid=000267
Prevention […] Many of the causes of achalasia cannot be prevented. However, treatment may help to prevent complications.
- #7 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #8 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #9 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #10 Achalasia Cardia Prevention – WelcomeCurehttps://www.welcomecure.com/diseases/achalasia-cardia/prevention
Adopting simple practices during meals can go a long way in helping our body fight diseases and prevent various disorders. […] Swallowing Therapy: This is a simple swallowing technique practiced with the help of a speech therapist which helps the patient in swallowing and eating better by adopting certain practices to strengthen the inner muscles. […] Certain swallowing exercises for the muscles can improve the tone and strength of lower esophageal sphincter. […] Dietary modifications- Alter your diet and meal pattern and choose a softer or a pureed diet which can help in swallowing better. […] Maintain a proper time period between each meal and avoid skipping meals. […] Always stay hydrated and increase the amount of fluids in your body. […] In extreme cases, alternate feeding in the form of use of nasal tube or tube feeding may be advised.
- #11 Achalasia Cardia Prevention – WelcomeCurehttps://www.welcomecure.com/diseases/achalasia-cardia/prevention
Adopting simple practices during meals can go a long way in helping our body fight diseases and prevent various disorders. […] Swallowing Therapy: This is a simple swallowing technique practiced with the help of a speech therapist which helps the patient in swallowing and eating better by adopting certain practices to strengthen the inner muscles. […] Certain swallowing exercises for the muscles can improve the tone and strength of lower esophageal sphincter. […] Dietary modifications- Alter your diet and meal pattern and choose a softer or a pureed diet which can help in swallowing better. […] Maintain a proper time period between each meal and avoid skipping meals. […] Always stay hydrated and increase the amount of fluids in your body. […] In extreme cases, alternate feeding in the form of use of nasal tube or tube feeding may be advised.
- #12 Achalasia Cardia Prevention – WelcomeCurehttps://www.welcomecure.com/diseases/achalasia-cardia/prevention
Adopting simple practices during meals can go a long way in helping our body fight diseases and prevent various disorders. […] Swallowing Therapy: This is a simple swallowing technique practiced with the help of a speech therapist which helps the patient in swallowing and eating better by adopting certain practices to strengthen the inner muscles. […] Certain swallowing exercises for the muscles can improve the tone and strength of lower esophageal sphincter. […] Dietary modifications- Alter your diet and meal pattern and choose a softer or a pureed diet which can help in swallowing better. […] Maintain a proper time period between each meal and avoid skipping meals. […] Always stay hydrated and increase the amount of fluids in your body. […] In extreme cases, alternate feeding in the form of use of nasal tube or tube feeding may be advised.
- #13 Achalasia Cardia Prevention – WelcomeCurehttps://www.welcomecure.com/diseases/achalasia-cardia/prevention
Adopting simple practices during meals can go a long way in helping our body fight diseases and prevent various disorders. […] Swallowing Therapy: This is a simple swallowing technique practiced with the help of a speech therapist which helps the patient in swallowing and eating better by adopting certain practices to strengthen the inner muscles. […] Certain swallowing exercises for the muscles can improve the tone and strength of lower esophageal sphincter. […] Dietary modifications- Alter your diet and meal pattern and choose a softer or a pureed diet which can help in swallowing better. […] Maintain a proper time period between each meal and avoid skipping meals. […] Always stay hydrated and increase the amount of fluids in your body. […] In extreme cases, alternate feeding in the form of use of nasal tube or tube feeding may be advised.
- #14 Achalasia and cancer prevention and surveillance – Del Grande – Annals of Esophagushttps://aoe.amegroups.org/article/view/5391/html
Achalasia is a well-known risk factor for esophageal cancer (EC). […] The patient must be informed about the risk of EC especially after 10 years, even treated. […] The treatment of achalasia with methods that increase risk of reflux (botulinum toxin injection, pneumatic dilation and per oral endoscopic myotomy) should be considered as a risk factor for adenocarcinoma. […] Surveillance may be considered in patients with more than 10 years of disease, especially if associated with other risk factors.
- #15 Achalasia and cancer prevention and surveillance – Del Grande – Annals of Esophagushttps://aoe.amegroups.org/article/view/5391/html
Achalasia is a well-known risk factor for esophageal cancer (EC). […] The patient must be informed about the risk of EC especially after 10 years, even treated. […] The treatment of achalasia with methods that increase risk of reflux (botulinum toxin injection, pneumatic dilation and per oral endoscopic myotomy) should be considered as a risk factor for adenocarcinoma. […] Surveillance may be considered in patients with more than 10 years of disease, especially if associated with other risk factors.
- #16 Achalasia and cancer prevention and surveillance – Del Grande – Annals of Esophagushttps://aoe.amegroups.org/article/view/5391/html
Achalasia is a well-known risk factor for esophageal cancer (EC). […] The patient must be informed about the risk of EC especially after 10 years, even treated. […] The treatment of achalasia with methods that increase risk of reflux (botulinum toxin injection, pneumatic dilation and per oral endoscopic myotomy) should be considered as a risk factor for adenocarcinoma. […] Surveillance may be considered in patients with more than 10 years of disease, especially if associated with other risk factors.
- #17 POEM Procedure: A Minimally Invasive Treatment for Achalasia > News > Yale Medicinehttps://www.yalemedicine.org/news/poem-peroral-endoscopic-myotomy-achalasia
POEM is a minimally invasive, endoscopic procedure for treating achalasia and other swallowing disorders. Learn about symptoms and treatment. […] Although some medications and surgery can help with achalasia, there is no cure. But now there is an endoscopic procedure called POEM (peroral endoscopic myotomy) that has proven to be highly effective at treating achalasia, and it doesn’t require making any surgical incisions in the abdomen.
- #18 Treatment and surveillance strategies in achalasia: an update | Nature Reviews Gastroenterology & Hepatologyhttps://www.nature.com/articles/nrgastro.2011.68
Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. […] Surveillance may lead to early recognition of cancer or late complications and should be considered after a disease duration of 10-15 years.
- #19 Achalasia and cancer prevention and surveillance – Del Grande – Annals of Esophagushttps://aoe.amegroups.org/article/view/5391/html
Achalasia is a well-known risk factor for esophageal cancer (EC). […] The patient must be informed about the risk of EC especially after 10 years, even treated. […] The treatment of achalasia with methods that increase risk of reflux (botulinum toxin injection, pneumatic dilation and per oral endoscopic myotomy) should be considered as a risk factor for adenocarcinoma. […] Surveillance may be considered in patients with more than 10 years of disease, especially if associated with other risk factors.
- #20 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #21 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #22 Achalasia secondary prevention – wikidochttps://www.wikidoc.org/index.php/Achalasia_secondary_prevention
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications. […] Achalasia patients need to eat slowly, chew very well, drink plenty of water with meals, and avoid eating near bedtime. […] Proton pump inhibitors may help prevent reflux damage after surgery by inhibiting gastric acid secretion. […] Even after successful treatment of achalasia, swallowing may still deteriorate over time. […] It’s important to check every year or two with a timed barium swallow because some may need pneumatic dilations, a repeat myotomy, or even esophagectomy after many years. […] Some doctors recommend pH testing and endoscopy to check for reflux damage, which may lead to a stricture or cancer of the esophagus if untreated.
- #23 Achalasia – Harvard Healthhttps://www.health.harvard.edu/a_to_z/achalasia-a-to-z
Since the cause of achalasia is unknown, there is no way to prevent it. […] There is no known cure for achalasia. But several treatments can provide good to excellent relief from symptoms for a number of years. When treatment needs to be repeated, it can be as successful as initial treatment.
- #24 UC San Diego Health Health Library | San Diego Hospital, Healthcarehttps://myhealth.ucsd.edu/conditions/Heart/134,167
Researchers dont know how to prevent achalasia. […] Treatment can help prevent long-term complications, such as: […] There is no known cure. But treatments can manage your symptoms. Treatment may include pneumatic dilation, botulinum toxin injections, surgery, or medicines.
- #25 Achalasia – Harvard Healthhttps://www.health.harvard.edu/a_to_z/achalasia-a-to-z
Since the cause of achalasia is unknown, there is no way to prevent it. […] There is no known cure for achalasia. But several treatments can provide good to excellent relief from symptoms for a number of years. When treatment needs to be repeated, it can be as successful as initial treatment.
- #26 UC San Diego Health Health Library | San Diego Hospital, Healthcarehttps://myhealth.ucsd.edu/conditions/Heart/134,167
Researchers dont know how to prevent achalasia. […] Treatment can help prevent long-term complications, such as: […] There is no known cure. But treatments can manage your symptoms. Treatment may include pneumatic dilation, botulinum toxin injections, surgery, or medicines.
- #27 POEM Procedure: A Minimally Invasive Treatment for Achalasia > News > Yale Medicinehttps://www.yalemedicine.org/news/poem-peroral-endoscopic-myotomy-achalasia
POEM is a minimally invasive, endoscopic procedure for treating achalasia and other swallowing disorders. Learn about symptoms and treatment. […] Although some medications and surgery can help with achalasia, there is no cure. But now there is an endoscopic procedure called POEM (peroral endoscopic myotomy) that has proven to be highly effective at treating achalasia, and it doesn’t require making any surgical incisions in the abdomen.