Obstruction-related dysphagia in inclusion body myositis: Cricopharyngeal bar on videofluoroscopy indicates risk of aspiration

Cricopharyngeal bar and dermatomyositis: A cause of rapidly progressive dysphagia

“…This suggests that the mechanism for dysphagia in these cases reflected a weakened UES and upper esophagus from inflammation of the oropharyngeal musculature rather than a CPB obstructing the esophagus. This finding is consistent throughout the literature, which is summarized in Table 1, wherein patients with dysphagia and an IIM without evidence of CPBs tend to respond to treatment with immunomodulatory therapy, 27–29 as opposed to IIM patients with CPBs who ultimately go on to need an interventional procedure to disrupt the cricopharyngeal fibers for adequate symptom control 3,13,14,16,18–20,26,30 …”

“…3,16 This differs compared to dysphagia in IIM associated with muscle weakness from inflammatory infiltration, which tends to show a low resting UES tone. 3,13,14,16,[18][19][20]26,30 Interestingly, when biopsied, CPBs in IIM patients tend to show an inflammatory infiltrate (Table 2), which can be consistent with the underlying myositic process. 3,[11][12][13][14]16,18 Several authors have observed patients with inclusion body myositis, and found histological features in the cricopharyngeal biopsies that resembled inclusion body myositis.…”

“…Cricopharyngeal bars occur in the general population without an underlying muscle disease and are a relatively frequent finding, being found in in 5%‐19% of patients who undergo a VFSS and are much more common in older people 21–23,26 . However, there have been several reports of an association between cricopharyngeal bars and IIM 1,3,8–20 . They have been found at increased rates in patients with an IIM compared to patients with a neurogenic cause of dysphagia as well as aged controls, 3 but similar to the general population, tend to occur in an older subset of patients 3,20,26 …”

“…However, there have been several reports of an association between cricopharyngeal bars and IIM 1,3,8–20 . They have been found at increased rates in patients with an IIM compared to patients with a neurogenic cause of dysphagia as well as aged controls, 3 but similar to the general population, tend to occur in an older subset of patients 3,20,26 …”

“…A CPB is a radiological description of the prominence of the cricopharyngeus and can be found incidentally in the general population and has also been described in the presence of IIM with suggested increased incidence in this population. 1,3,[8][9][10][11][12][13][14][15][16][17][18][19][20] In this case report we present a patient with dermatomyositis who presented with dysphagia and a CPB and discuss the significance of these findings.…”