失弛缓性, a rare 吞咽障碍, is a lifelong condition that may have serious symptoms. 通过适当的治疗，症状可以得到控制，这样它们就不会扰乱日常生活.

什么是失弛缓症?

失弛缓症是一种罕见的 吞咽障碍 这会影响食道(喉咙和胃之间的管道). 在贲门失弛缓症患者中, the esophagus muscles do not contract properly and do not help propel food down toward the stomach. 同时, 食道底部的肌肉环, 称为食管下括约肌(LES), 是无法放松让食物进入胃里.

失弛缓症通常影响30至60岁的成年人，在40多岁时达到高峰. 这种疾病在男性中的发病率是女性的两倍.

失弛缓性原因

失弛缓症的病因尚不清楚，但研究人员正在探索几种理论. One is related to degeneration of the nerve cells located between the layers of esophageal muscles. 这些神经细胞使食道能够推动食物进出胃.

Some studies suggest a possible relationship between achalasia and parasitic or viral infections. 患有失弛缓症的人可能更有可能显示出以前感染的证据, 比如单纯疱疹病毒的抗体, 人类乳头状瘤病毒, 麻疹病毒和其他病毒.

也有证据表明失弛缓症可能是一种炎症性自身免疫性疾病, 也就是说它可能是由身体自我攻击引起的. 研究ers have seen signs of immune system activity in the nerve cells that empower esophageal muscles. 此外，贲门失弛缓症患者为3.患葡萄膜炎等自身免疫性疾病的可能性是正常人的6倍, I型糖尿病, 类风湿性关节炎, 系统性红斑狼疮及Sjögren综合征.

失弛缓性症状

Some achalasia symptoms are caused by food piling up in the esophagus and being unable to pass into the stomach. 当食道填满时，它会变宽并扭曲. Other achalasia symptoms are related to the abnormal contractions of the esophageal muscles.

失弛缓症的症状发生在进食期间或进食后. 它们包括:

• The feeling that food or liquid are hard to swallow and are getting caught in the esophagus or “sticking” on the way down to the stomach (this is the most common symptom of achalasia)
• 反流(食物和液体在吞咽后回流到嘴里)
• 胸痛，可能会很严重，使人从睡眠中醒来
• 胃灼热
• 咳嗽，尤其是在晚上
• 窒息，或将食物或液体吸入气道(误吸)

胸痛和反流, 失弛缓症患者可能会经历的一些最初症状, 也与 胃食管反流障碍(GERD)). 然而，这两种情况是不同的. 胃食管反流是由食管下括约肌过于松弛引起的, 使胃酸进入食道. 贲门失弛缓症，括约肌太紧.

失弛缓症的症状会变得很严重. Severe achalasia may lead to significant chest pain, fatigue, malnutrition and 减肥. 如果食物颗粒进入气道由于咳嗽和噎住吃饭, 它会导致肺炎——气道炎症，危及生命.

失弛缓症的类型

贲门失弛缓症患者食道肌肉功能障碍的方式各不相同. 在所有失弛缓症的病例中, the lower esophageal sphincter that controls the passage between the esophagus and the stomach fails to relax at the right time. Based on other problems that happen at the same time, doctors identified three types of achalasia:

• 1型失弛缓症 有时被称为经典贲门失弛缓症. With this type, the esophagus muscles barely contract, so food moves down because of gravity alone.
• In 2型失弛缓症这时，压力在食道内积聚，导致它被压缩. This is the most common type of achalasia and it often causes more severe symptoms than type I.
• III型失弛缓症 is sometimes called spastic achalasia because there are abnormal contractions at the bottom of the esophagus where it meets the stomach. 这是最严重的失弛缓症. The contractions can cause chest pain that can awaken a person from sleep and imitate the symptoms of a heart attack.

失弛缓性诊断

In addition to a thorough physical examination and review of your medical history and symptoms, 你的医生可能会推荐以下测试来帮助诊断失弛缓症.

• 咽, 食管测压法 to measure and record changes in pressure throughout the throat and esophagus as you swallow. 一些人认为测压法是失弛缓症最可靠的检测方法, since it can detect the location and severity (or lack of) muscle contractions that affect the ability to swallow.
• 胃镜检查 to examine the esophagus and stomach using an endoscope — a thin tube with a camera that is inserted through the mouth. This test helps see abnormalities in the esophagus such as strictures (narrowing) and tumors. During endoscopy, your doctor can perform a biopsy or remove abnormal tissue for further analysis.
• 无线pH值测试 or 24小时pH阻抗测试 to evaluate the acidity in the esophagus during an extended period and rule out other conditions such as GERD.
• 吞钡, an imaging test that uses the contrast medium barium and X-rays to create images of the upper gastrointestinal (GI) tract. 该检查可显示食管明显狭窄, 这种鸟喙有时被称为失弛缓症鸟喙.

失弛缓性治疗

目前, 没有任何治疗可以完全解决失弛缓症, 但有几种方法可以缓解症状, 比如膨胀, 手术, 注射肉毒杆菌毒素和药物. The goal of treatment is to normalize contractions in the esophagus and help the sphincter relax and allow food to pass into the stomach.

食管括约肌扩张

通道的扩张意味着拓宽它. 在贲门失弛缓症的扩张过程中, the patient is asleep while a gastroenterologist inserts an endoscope into the mouth and esophagus, 慢慢地给食管下括约肌附近的气球充气. This can decrease the pressure in the esophagus and stretch the sphincter muscles until they relax enough to allow food and liquid to pass through easily.

球囊扩张可能是治疗贲门失弛缓症最常见的方法. Most patients (65% to 80%) report a significant improvement of swallowing after the procedure. 然而, 这种改善可能是暂时的——贲门失弛缓症的症状会随着时间的推移而复发, 呼吁进一步治疗.

贲门失弛缓症手术-食道肌切开术

在肌切开术, 胃肠病学家切开食道的肌肉, 食管括约肌和下胃防止它们收紧.

贲门失弛缓症肌切开术可通过口腔内窥镜(经口内窥镜肌切开术)或通过腹部的几个小切口(腹腔镜Heller肌切开术). A lower esophageal sphincter myotomy disrupts just enough muscle to relieve achalasia symptoms but not enough to cause acid reflux. This is the most permanent solution for achalasia, but it is not appropriate for all patients.

贲门失弛缓症的前沿治疗- POEM程序

肉毒杆菌毒素注射

Injecting botulinum toxin into the lower esophageal sphincter has been shown to help some patients who have achalasia. These treatments are particularly useful for older patients and those who are not candidates for dilation or myotomy.

Botulinum toxin injections for achalasia work by numbing the sphincter and surrounding nerves, 让它放松. 注射是用一根特殊的针穿过内窥镜进行的. 它们的效果有限，持续大约一年. 可能需要重复注射. 有些推荐十大正规网赌平台可能会感到轻微的胸痛, 有报道称，这种治疗后会出现皮疹.

治疗失弛缓症的药物

药物通常对贲门失弛缓症无效. Some drugs containing nitrates or calcium channel blockers can help temporarily relax the lower esophageal sphincter. 然而, they must be taken before every meal, and their side effects usually outweigh the benefits.

与失弛缓症一起生活

如果在失弛缓症治疗后仍有症状, 你应该和你的医生一起寻找其他的解决办法. 调整饮食, 饮食习惯或其他生活方式因素会影响你的生活质量.

有无失弛缓症饮食法?

没有任何饮食被证明能帮助缓解失弛缓症症状, but you should discuss with your doctor or a speech-language pathologist if you should change what you eat. Certain foods can be harder or less difficult to swallow depending on the type of achalasia you have. 也, 如果你因为失弛缓症而瘦了很多, your doctor may recommend high calorie foods to make sure you have a healthy body mass index.

有些失弛缓症患者在避免某些食物时感觉更好，例如:

• 生水果和蔬菜
• 切得硬的肉
• 高酸性食物，如柑橘类水果
• 酒精
• 咖啡因

怎么吃、什么时候吃也会产生影响. 小口的食物，仔细咀嚼，可以更容易吞咽. 睡前不吃固体食物可以减少夜间胸痛和反流.

失弛缓症致命吗?

人们通常不会因为失弛缓症而死亡. 尽管这是一种终生的疾病, 通过症状管理, 你可以避免贲门失弛缓症最严重的并发症, 比如渴望, 窒息和营养不良.

贲门失弛缓症患者患食道癌的风险更高. Discuss with your doctor if you have family history of this type of cancer or other factors that may further increase your risk.