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Akalasi

Senast uppdaterad: Senast reviderad:
Sakkunnig:

Definition:
Motilitetssjukdom i esofagus som karakteriseras av nedsatt peristaltik i distala 2/3 delarna av esofagus och avsaknad av reaktion från den nedre esofagala sfinktern (LES).
Förekomst:
Prevalensen verkar vara cirka 10 fall per 100 000 personer.
Symtom:
Sväljsvårigheter (dysfagi) är huvudsymtomet och förekommer hos cirka 90 %.
Kliniska fynd:
Finns egentligen inga relevanta kliniska fynd.
Diagnostik:
Gastroskopi, eventuellt kompletterande röntgen, ger diagnosen.
Behandling:
Läkemedelsbehandling har endast en övergående effekt. Lapraskopiskt kan myotomi med delvis fundoplikation utföras.
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  2. Leyden JE, Moss AC, MacMathuna P. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev. 2014;12:CD005046. doi: 10.1002/14651858.CD005046.pub3. Epub 2014 Dec 8. The Cochrane Library  
  3. Patel DA, Kim HP, Zifodya JS, et al. Idiopathic (primary) achalasia: a review. Orphanet J Rare Dis. 2015 Jul 22;10:89. doi: 10.1186/s13023-015-0302-1 DOI  
  4. Enestvedt BK, Williams JL, Sonnenberg A.. Epidemiology and practice patterns of achalasia in a large multi-centre database.. Aliment Pharmacol Ther. 2011; 33(11): 1209-1214. PubMed  
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  7. Blam ME, Delfyett W, Levine MS, et al. Achalasia: a disease of varied and subtle symptoms that do not correlate with radiographic findings. Am J Gastroenterol. 2002;97:1916-1923. PubMed  
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  11. Ponds FA, Fockens P, Lei A, et al. Effect of Peroral Endoscopic Myotomy vs Pneumatic Dilation on Symptom Severity and Treatment Outcomes Among Treatment-Naive Patients With Achalasia A Randomized Clinical Trial. JAMA 2019; 322: 134-44. pmid:31287522. www.ncbi.nlm.nih.gov  
  12. Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol 23 July 2013. doi:10.1038/ajg.2013.196 DOI  
  13. Leyden JE, Moss AC, MacMathuna P.. Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia.. Cochrane Database Syst Rev. 2014; 12: CD005046. . doi:10.1002/14651858.CD005046 DOI  
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  15. Allaix ME, Patti MG. Endoscopic dilatation, heller myotomy, and peroral endoscopic myotomy: treatment modalities for achalasia. Surg Clin North Am. 2015 Jun;95(3):567-78. doi: 10.1016/j.suc.2015.02.009. DOI  
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  17. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364: 1807-16. New England Journal of Medicine  
  18. Vanuytsel T, Lerut T, Coosemans W, et al. Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clin Gastroenterol Hepatol 2012; 10: 142-9. pmid: 22064041 PubMed  
  19. Zendehdel K, Nyrén O, Edberg A et. al. Risk of Esophageal Adenocarcinoma in Achalasia Patients, a Retrospective Cohort Study in Sweden . Am J Gastroenterol 2011; 106: 57-61. PubMed  
  20. Frankhuisen R, van Herwaarden MA, Heijkoop R, et al. Persisting symptoms and decreased health-related quality-of-life in a cross-sectional study of treated achalasia patients. Aliment Pharmacol Ther. 2007;26:899-904. PubMed  
  • Athena Adeli, legitimerad läkare, Karolinska Institutet
  • Tidigare: Henrik Forssell, docent och överläkare, Kirurgkliniken, Blekingesjukhuset, Karlskrona

Tidigare sakkunniga

  • Henrik Forssell, docent och överläkare, Kirurgkliniken, Blekingesjukhuset, Karlskrona