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アハラシア:体系的なレビュー
John E Pandolfino1, Andrew J Gawron2
1Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
JAMA
|May 13, 2015
まとめ
アハラシアの診断には,阻害が排除されたときに,消化不全と耐火性逆流を考慮する必要があります. この食道運動障害に対する治療の成功は,サブタイプによって異なるため,患者の治療結果に影響を及ぼします.
科学分野:
- 胃腸内科 胃腸内科
- 食道運動障害 食道運動障害
- 手術と内視鏡による介入
背景:
- アハラシアは食道運動障害であり,患者の生活の質に大きな影響を与えます.
- アハラシアの診断と治療は,臨床医にとって挑戦的かもしれません.
研究 の 目的:
- アハラシアの診断と管理をレビューする.
- フェノタイプ分類とその治療結果との関係に焦点を当てること.
主な方法:
- 広範な文献レビューとMEDLINE検索が行われました.
- 2004年1月から2015年2月にかけて掲載された記事を含む.
- 内視鏡療法または外科療法に関する9件のランダム化比較試験を分析した.
主要な成果:
- アハラシアは,機能不全,胸痛,または機械的な障害のない耐火性逆流の患者で疑われるべきである.
- アカラシアの疑いがある場合はマノメトリーが推奨されます.
- 肺拡張 (70%~90%) と腹腔鏡筋切除 (88%~95%) は,下側食道軟骨管の損傷に対する効果的な治療法である.
- 予後はアハラシアサブタイプによって異なります:タイプIIは非常に好ましい結果 (96%),タイプIは中間 (81%),タイプIIIはより好ましくない (66%).
結論:
- 原因不明の難食症では,特に阻害や炎症がない場合,アハラシアを考慮してください.
- アカラシアにおける治療への反応は,特定された特定のサブタイプによって著しく影響を受けます.
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