Pharyngeal Dysphagia in Inflammatory Muscle Diseases Resulting from Impaired Suprahyoid Musculature

Langdon, P. Claire; Mulcahy, Kylie; Shepherd, Kelly; Low, V. H. S.; Mastaglia, Frank

doi:10.1007/s00455-011-9384-7

Cited by 56 publications

(51 citation statements)

References 32 publications

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“…The mechanism of dysphagia of DM remains unclear. A recent study using VFSS and manometry indicated that dysphagia in inflammatory muscle diseases may be due to impaired muscle contraction and reduced hyolaryngeal excursion than the often held belief of failed upper esophageal sphincter relaxation [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies

et al. 2016

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ObjectiveDysphagia develops with low frequency in patients with dermatomyositis. Our objective was to determine the clinical and laboratory features that can estimate the development of dysphagia in dermatomyositis.MethodsThis study included 92 Japanese patients with adult-onset dermatomyositis. The associations between dysphagia and clinical and laboratory features including disease-specific autoantibodies determined by immunoprecipitation assays were analyzed.ResultsVideofluoroscopy swallow study (VFSS) was performed for all patients with clinical dysphagia (n = 13, 14.1%) but not for patients without clinical dysphagia. Typical findings of dysphagia (pharyngeal pooling, n = 11 and/or nasal regurgitation, n = 4) was detected by VFSS in all patients with clinical dysphagia. Eleven patients with dysphagia (84.6%) had anti-transcription intermediary factor 1γ (TIF-1γ) antibody. By univariate analysis, the average age and the male to female ratio, internal malignancy, and anti-TIF-1γ antibody were significantly higher and the frequency of interstitial lung diseases and manual muscle testing (MMT) scores of sternomastoid and dertoid muscles were significantly lower in patients with dysphagia than in patients without dysphagia. Among patients with anti-TIF-1γ antibody, the mean age, the ratios of male to female and internal malignancy were significantly higher and mean MMT scores of sternomastoid muscle were significantly lower in patients with dysphagia compared with patients without dysphagia. By multivariable analysis, the risk of dysphagia was strongly associated with the existence of internal malignancy and ant-TIF-1γ antibody and was also associated with reduced scores of manual muscle test of sternomastoid muscle. Dysphagia was markedly improved after the treatment against myositis in all 13 patients.ConclusionThese findings indicate that dysphagia can develop frequently in patients with internal malignancy, anti-TIF-1γ antibody, or severe muscle weakness of sternomastoid muscle.

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Section: Discussionmentioning

confidence: 99%

Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies

et al. 2016

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“…Cricopharyngeomyotomy is used when the underlying mechanisms of dysphagia is failed relaxation of the upper esophageal sphincter. This intervention may not be beneficial with normal relaxation and other mechanisms of dysphagia, i.e., delayed swallow initiation and decreased hyolaryngeal excursion ( 138 ). Other interventions include percutaneous endoscopic gastrostomy (PEG), pharyngoesophageal dilatation, and injection of botulinum toxin ( 139 – 141 ).…”

Section: Treatmentmentioning

confidence: 99%

Idiopathic Inflammatory Myopathies: Clinical Approach and Management

et al. 2016

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Idiopathic inflammatory myopathies (IIM) are a group of chronic, autoimmune conditions affecting primarily the proximal muscles. The most common types are dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis (sIBM). Patients typically present with sub-acute to chronic onset of proximal weakness manifested by difficulty with rising from a chair, climbing stairs, lifting objects, and combing hair. They are uniquely identified by their clinical presentation consisting of muscular and extramuscular manifestations. Laboratory investigations, including increased serum creatine kinase (CK) and myositis specific antibodies (MSA) may help in differentiating clinical phenotype and to confirm the diagnosis. However, muscle biopsy remains the gold standard for diagnosis. These disorders are potentially treatable with proper diagnosis and initiation of therapy. Goals of treatment are to eliminate inflammation, restore muscle performance, reduce morbidity, and improve quality of life. This review aims to provide a basic diagnostic approach to patients with suspected IIM, summarize current therapeutic strategies, and provide an insight into future prospective therapies.

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“…However, scleroderma and DM-PM significantly surpass the other CTDs concerning this complication, due to the fact that both diseases are characterized by pathophysiologic mechanisms seriously predisposing to impaired function of swallowing and thus to overt acute aspiration or occult chronic microaspiration of oropharyngeal and/or gastropharyngeal contents [143,184]. In scleroderma, the gastrointestinal tract is the internal system most commonly involved.…”

Section: Acute Gastroesophageal Content Aspiration Pneumonitismentioning

confidence: 99%

“…Poor oral hygiene, tooth loss, decreased saliva production, and periodontal disease are also frequently encountered in scleroderma patients, further aggravating the risk of aspiration pneumonia [187]. In DM-PM, on the other hand, dysphagia seems to be mostly related to impaired muscle contraction, reduced hyoid-laryngeal excursion, and/or failed upper esophageal sphincter relaxation [19,143,188]. …”

Section: Acute Gastroesophageal Content Aspiration Pneumonitismentioning

confidence: 99%

“…Prompt acquisition of the diagnosis is mandatory because of the precipitating or already precipitated hypercapnic respiratory failure and the necessity of obviating infections [16]. Infections are related to the coexistence of pharyngeal muscle involvement and weakness, predisposing to aspiration pneumonia and ineffectiveness of cough as well as reduced clearance of lung secretions associated with generalized thoracoabdominal muscle weakness [19,143]. Treatment remains empirical and includes steroids and/or immunosuppressants, intravenous immunoglobulins, biological factors, and rituximab [16].…”

Section: Acute Hypercapnic Respiratory Failure Related To Acute Ventimentioning

confidence: 99%

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Acute Respiratory Events in Connective Tissue Disorders

Papiris¹,

Manali²,

Kolilekas³

et al. 2016

Respiration

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Subacute-acute, hyperacute, or even catastrophic and fulminant respiratory events occur in almost all classic connective tissue disorders (CTDs); they may share systemic life-threatening manifestations, may precipitously lead to respiratory failure requiring ventilatory support as well as a combination of specific therapeutic measures, and in most affected patients constitute the devastating end-of-life event. In CTDs, acute respiratory events may be related to any respiratory compartment including the airways, lung parenchyma, alveolar capillaries, lung vessels, pleura, and ventilatory muscles. Acute respiratory events may also precipitate disease-specific extrapulmonary organ involvement such as aspiration pneumonia and lead to digestive tract involvement and heart-related respiratory events. Finally, antirheumatic drug-related acute respiratory toxicity as well as lung infections related to the rheumatic disease and/or to immunosuppression complete the spectrum of acute respiratory events. Overall, in CTDs the lungs significantly contribute to morbidity and mortality, since they constitute a common site of disease involvement; a major site of infections related to the ‘mater' disease; a major site of drug-related toxicity, and a common site of treatment-related infectious complications. The extreme spectrum of the abovementioned events, as well as the ‘vicious' coexistence of most of the aforementioned manifestations, requires skills, specific diagnostic and therapeutic means, and most of all a multidisciplinary approach of adequately prepared and expert scientists. Avoiding lung disease might represent a major concern for future advancements in the treatment of autoimmune disorders.

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Pharyngeal Dysphagia in Inflammatory Muscle Diseases Resulting from Impaired Suprahyoid Musculature

Cited by 56 publications

References 32 publications

Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies

Oropharyngeal Dysphagia in Dermatomyositis: Associations with Clinical and Laboratory Features Including Autoantibodies

Idiopathic Inflammatory Myopathies: Clinical Approach and Management

Acute Respiratory Events in Connective Tissue Disorders

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