Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches

McMillan, Ryan A.; Bowen, Andrew J.; Bayan, Semirra L.; Kasperbauer, Jan L.; Ekbom, Dale C.

doi:10.1002/lary.29444

Cited by 9 publications

(10 citation statements)

References 18 publications

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“…In our study, a cricopharyngeal bar was found in 64% of patients with dysphagia onset, which led to cricopharyngeal myotomy or balloon dilatation in all patients. These interventions can be of symptomatic benefit, 20,29 but their effect on survival among IBM patients is yet to be shown. Last, IBM should be suspected in at-risk patients presenting with isolated dysphagia.…”

Section: Discussionmentioning

confidence: 99%

Atypical presentations of inclusion body myositis: Clinical characteristics and long‐term outcomes

2022

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Introductions/Aims Inclusion body myositis (IBM) typically presents with progressive weakness preferentially involving finger flexors and quadriceps. Atypical presentations have been less commonly reported. Here, we aim to describe the clinical characteristics and long‐term outcomes of IBM patients with atypical presentations. Methods We retrospectively searched the Mayo Clinic medical records to identify IBM patients with atypical disease onset, seen between 2015 and 2020. Results We identified 357 IBM patients, of whom 50 (14%) had an atypical presentation. Thirty‐eight patients were diagnosed with IBM because they fulfilled one of the European Neuromuscular Center diagnostic categories at a later stage, 10 had all IBM histopathological features, and 2 were diagnosed on the basis of clinical and laboratory data. The most common presentation was dysphagia (50%), followed by asymptomatic hyperCKemia (24%; CK, creatine kinase), then foot drop (12%). 6% of patients presented with proximal arm weakness, 4% with axial weakness and 4% with facial diplegia. Median time from symptom onset to diagnosis was 9 y. Median age at diagnosis was 70.5 y. 16% of patients needed a walking aid. When tested, 86.5% of patients had impaired swallowing and 56% had elevated cytosolic nucleotidase‐1A antibodies. Only 1/26 patients who received immunotherapy had minimal improvement. Upon follow‐up, most patients had generalization of their weakness with a decline in their strength summated score of 0.082/mo. Discussion A significant proportion of IBM patients may have an atypical presentation. Recognition of such heterogeneity could improve early diagnosis, prevent unnecessary immunotherapy, and provide insight for future diagnostic criteria development and clinical trials.

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Section: Discussionmentioning

confidence: 99%

Atypical presentations of inclusion body myositis: Clinical characteristics and long‐term outcomes

2022

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“…Cricopharyngeal myotomy was reported to be an effective procedure in several previous studies when used appropriately, using either an endoscopic or transcervical approach. 5,6,13,20,21 There were several limitations to this study. There was a small sample size, but inclusion body myositis is a rare condition.…”

Section: Discussionmentioning

confidence: 96%

“…Cricopharyngeal myotomy was reported to be an effective procedure in several previous studies when used appropriately, using either an endoscopic or transcervical approach. 5,6,13,20,21…”

Section: Discussionmentioning

confidence: 99%

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic

et al. 2022

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Objective This study reviewed patients with inclusion body myositis who were referred for assessment of dysphagia at a tertiary swallow clinic. It describes symptoms at presentation, imaging and management strategies. Method A retrospective review of electronic patient records was performed between 2016 and 2020. Results Twenty-four patients were included, with a mean age of 72 years. Baseline modified Sydney Swallow Questionnaires identified problems with hard or dry food, food sticking, and repeated swallowing. Twenty-two patients had a Reflux Symptom Index score that could indicate significant reflux. Video swallow identified specific problems, including tongue base retraction (96 per cent) and residual pharyngeal pooling (92 per cent). Seven patients (30 per cent) had features of aspiration on imaging despite a median penetration-aspiration scale score of 2. Four patients received balloon dilatation, and two patients underwent cricopharyngeal myotomy. Conclusion This study helped to profile features of dysphagia in patients with inclusion body myositis. More evidence is needed to determine the most effective management pathway for these patients.

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“…Nevertheless, interesting data emerged for botulinum, which has been effectively employed in a small cohort of IBM pa-tients (153). Similarly, cricopharyngeal myotomy may be an effective and durable technique in IBM in case of recalcitrant dysphagia (103,154). Prophylaxis against Pneumocystis jiroveci (PJ), too, should not be overlooked.…”

Section: Take-home Messagesmentioning

confidence: 99%

Idiopathic inflammatory myopathies: one year in review 2022

Cardelli

Zanframundo

Cometi

et al. 2023

Clinical and Experimental Rheumatology

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Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of disorders in which chronic inflammation of the skeletal muscle, leading to muscle weakness, is a common feature. Different phenotypes have been identified within the IIM spectrum based on extra-muscular manifestations, immunology, muscle histology, responsiveness to therapy, and prognosis. The pathogenesis, classification, treatment, and prognosis of the different IIM subtypes are subject to active discussion and research. This review highlights the most relevant literature published on this topic over the last year.

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Cricopharyngeal Myotomy in Inclusion Body Myositis: Comparison of Endoscopic and Transcervical Approaches

Cited by 9 publications

References 18 publications

Atypical presentations of inclusion body myositis: Clinical characteristics and long‐term outcomes

Atypical presentations of inclusion body myositis: Clinical characteristics and long‐term outcomes

Inclusion body myositis and dysphagia. Presentation, intervention and outcome at a swallowing clinic

Idiopathic inflammatory myopathies: one year in review 2022

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