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Akalasi

Sist revidert:
Sist revidert av:


Definisjon:
Motilitetssykdom i øsofagus karakterisert ved nedsatt peristaltikk i distale 2/3 av øsofagus og manglende relaksasjon av den nedre øsofageale sfinkter (LES)
Forekomst:
Prevalens angis å være ca. 10 per 100.000
Symptomer:
Svelgevansker (dysfagi) er hovedsymptomet og forekommer hos ca. 90%
Funn:
Ingen relevante kliniske funn
Diagnostikk:
Gastroskopi, ev. supplerende røntgen, gir diagnosen
Behandling:
Medikamenter har kun forbigående effekt. Laparoskopisk Heller myotomi med delvis fundoplikasjon synes å være førstevalg
  1. Kang J-Y, Alexandropoulou K. Achalasia. BMJ Best Practice, last updated 06 Oct 2020. bestpractice.bmj.com  
  2. Pandolfino JE, Gawron AJ. Achalasia. A systematic review. JAMA. 2015;313(18):1841-1852 . doi:10.1001/jama.2015.2996 DOI  
  3. Wilkinson JM, Halland M. Esophageal Motility Disorders. Am Fam Physician. 2020;102(5):291-296. PMID: 32866357 PubMed  
  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  
  5. Booy JD, Takata J, Tomlinson G, et al. The prevalence of autoimmune disease in patients with esophageal achalasia. Dis Esophagus. 2012;25:209-213 PubMed  
  6. Tsuboi K, Hoshino M, Srinivasan A, et al. Insights gained from symptom evaluation of esophageal motility disorders: a review of 4,215 patients. Digestion. 2012;85(3):236-242. PubMed  
  7. Sinan H, Tatum RP, Soares RV, Martin AV, Pellegrini CA, Oelschlager BK. Prevalence of respiratory symptoms in patients with achalasia. Dis Esophagus. 2011;24(4):224-228. PubMed  
  8. Kopelman Y, Triadafilopoulos G. Endoscopy in the diagnosis and management of motility disorders. Dig Dis Sci. 2011;56:635-654. PubMed  
  9. Roll GR, Rabl C, Ciovica R et.al. A controversy that has been tough to swallow: is the treatment of achalasia now digested?. J Gastrointest Surg 2010; 14: 33-45. PubMed  
  10. Schuchert MJ, Luketich JD, Landreneau RJ. Minimally-invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes. Ann Thorac Surg 2008; 85: 1729-34. PubMed  
  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 PubMed  
  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. Cochrane (DOI)  
  14. Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Science 2009; 54: 2303-11. PubMed  
  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  
  16. 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  
  17. 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  
  18. Katzka DA, Castell DO. Review article: an analysis of the efficacy, perforation rates and methods used in pneumatic dilation for achalasia. Aliment Pharmacol Ther. 2011;34:832-839. 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  
  • Ingard Løge, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Hermod Petersen, professor og overlege, Norges teknisk-naturvitenskapelige universitet og Medisinsk avdeling, Regionsykehuset i Trondheim
  • Eiliv Brenna, spesialist i gastroenterologi og overlege, Medisinsk avdeling, Regionsykehuset i Trondheim
  • Per Martin Kleveland, professor i gastroenterologi, Norges teknisk-naturvitenskapelige universitet og overlege gastroenterologisk avdeling St. Olavs Hospital, Trondheim