Dysphagia in Inclusion Body Myositis, A Disease of the Elderly

Abstract

Inclusion body myositis is one of the most common acquired myopathies seen in the aging population. The muscle weakness is of insidious onset, frequently starting in the legs, but over time gradually progresses to eventually involve all skeletal muscles of the limbs, face, swallowing and respiratory muscles, leading to significant morbidity and mortality. Complications resulting from dysphagia are the leading cause of poor quality of life and mortality, while highly prevalent, are still underappreciated and underrecognized. This review highlights the importance of understanding the urgent need for recognizing and improving the evaluation, outcome measures and therapeutic options of dysphagia in inclusion body myositis patients.

Imaging swallowing function and the mechanisms driving dysphagia in inclusion body myositis.

“…1) (4). Within that, upper oesophageal sphincter (UES) dysfunction is often described as a key biomechanical component (4,13). The UES itself is composed of the inferior pharyngeal constrictor, CP and superior oesophagus (31).…”

“…(31) Impaired muscle contraction within the pharyngeal wall and reduced pharyngeal propulsion has been documented (12,16,33,40,41). Not only does this result in reduced bolus transit, but the lower pressure exerted from abnormal pharyngeal contraction may limit UES opening (13,31). Deficits in tongue function, such as reduced base retraction and impaired tongue control have been noted in IBM (16,33).…”

“…-Flexible endoscopic evaluation of swallowing Flexible endoscopic evaluation of swallowing (FEES) is used to assess swallowing and upper airway function in clinical practice. A nasoendoscope is introduced via the nasal cavity to visualise the hypopharynx and larynx (4,13). Food and liquids are also administered during visualisation.…”

“…However, FEES doesn't allow detailed evaluation of the oral or oesophageal swallowing stages and biomechanical movements. In IBM patients artefact during FEES from 'white out' from residues hinder visualisation during the pharyngeal phase (13). A limited number of studies have explored the use of FEES in IBM (16,33,36), with some offering only limited insights into the FEES phenotype of IBM patients.…”

“…Asking about these symptoms could be a useful way to evaluate presence or absence of dysphagia in IBM (12). Other patient complaints include nasal regurgitation, coughing and choking (12,13). In some patients, dysphagia is the most prominent symptom and cause for severe morbidity.…”