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Behandlung der Achalasie

Treatment of achalasia

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Summary

Achalasia is a condition of unknown etiology. It represents a motor disorder of the esophagus characterized by absent or incomplete relaxation of the lower esophageal sphincter upon swallowing and by nonpropulsive swallow-induced contraction waves or amotility of the esophageal body. Dysphagia and regurgitation of ingesta are the most frequent symptoms. Medical treatment, i.e. by calcium-channel blockers and nitric oxide donors, may be tried in patients with mild dysphagia or in elderly patients but rarely yields adequate symptom relief. Mechanical dilatation of the achalasic sphincter may be performed as an initial treatment option. Intrasphincteric injections of botulinum toxin seemed to be a promising alternative, but it has become obvious that, in most cases, repeated applications of the toxin are required to maintain patients symptom-free. Myotomy of the achalasic sphincter with or without fundoplication to prevent gastroesophageal reflux, is employed mainly in patients in whom dilatations have failed, but since the introduction of minimally invasive surgery, myotomy has become the primary treatment at many centers. This article aims to provide an overview of the development of the conservative and surgical treatment of achalasia.

Zusammenfassung

Die Achalasie ist eine Motilitätsstörung der Speiseröhre unklarer Ätiologie. Sie ist durch eine fehlende oder nur geringe Relaxation des gastroösophagealen Sphinkters während des Schluckaktes und durch zumindest zum Teil nichtpropulsive Kontraktionswellen oder eine komplette Amotilität des Ösophaguskörpers gekennzeichnet. Klinisch äußert sie sich vor allem in Dysphagie und Regurgitationen. Eine medikamentöse Therapie ist bei geringgradiger Dysphagie möglich, bei ausgeprägter Dysphagie stellt die mechanische Dilatation eine initiale Therapieoption dar. Botulinumtoxin-Injektionen in den ösophagogastrischen Übergangsbereich schienen zunächst vielversprechend, es erwies sich aber, dass die Wirkung nur kurz anhält und wiederholte Applikationen erforderlich sind. Die chirurgische Behandlung, nämlich die Myotomie mit oder ohne Antirefluxplastik, wird vor allem nach erfolglosen Dilatationen durchgeführt, seit der Einführung minimal-invasiver chirurgischer Techniken aber zunehmend als primäre Therapie angewandt. Die vorliegende Arbeit gibt einen Überblick über die Entwicklung der konservativen und chirurgischen Behandlungsmethoden.

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  1. Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, A-1090, Wien, Österreich

    Enrico P. Cosentini, Etienne Wenzl & Raimund Jakesz

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  1. Enrico P. Cosentini
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Cosentini, E.P., Wenzl, E. & Jakesz, R. Behandlung der Achalasie. Wien Klin Wochenschr 116, 296–304 (2004). https://doi.org/10.1007/BF03040899

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