Konservative Therapie

  • T. Eberl
  • J. Barnert
  • M. Wienbeck

Zusammenfassung

Bei der Achalasie, als erste Motilitätsstörung der Speiseröhre 1672 von Thomas Willis beschrieben, handelt es sich um eine neuromuskuläre Erkrankung der Speiseröhre, bedingt durch eine Reduktion intramuraler Ganglienzellen im myenterischen Plexus sowohl im tubulären Ösophagus als auch im unteren ösophagealen Sphinkter. Dadurch ist die Ösophagusmotilität in zweifacher Weise gestört: Der untere Ösophagussphinkter erschlafft beim Schlucken unvollständig oder überhaupt nicht, ferner fehlt in den unteren 2/3 der tubulären Speiseröhre die Peristaltik. Da die Ätiologie der Achalasie weiterhin unklar bleibt, ist die Behandlung palliativ, eine kausale Behandlung nicht möglich. Alle therapeutischen Maßnahmen richten sich auf die wichtigste Störung, die funktionelle Obstruktion des unteren Ösophagussphinkers. Dieser Sphinkter muß so geschwächt werden, daß er durch den hydrostatischen Druck der andrängenden Speisen und Getränke mühelos überwunden werden kann, gleichzeitig jedoch ein gastroösophagealer Reflux vermieden wird. Die Optionen der konservativen Therapie der Achalasie beinhalten somit Medikamente mit Wirkung auf den unteren Ösophagussphinker wie auch auf die mechanische Dilatation des unteren Sphinkters mittels intraluminaler Maßnahmen. Ferner sollen hier auch neue Therapiestrategien beschrieben werden, die auf der intrasphinktären Injektion von Botulinustoxin beruhen.

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Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • T. Eberl
  • J. Barnert
  • M. Wienbeck

There are no affiliations available

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