Dysphagia in Inclusion Body Myositis, A Disease of the Elderly

Goyal, Namita; Mozaffar, Tahseen

doi:10.21926/obm.geriatr.2101154

Cited by 3 publications

(5 citation statements)

References 49 publications

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“…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).…”

Section: Pathophysiology Of Dysphagia In Ibmmentioning

confidence: 99%

“…(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).…”

Section: Mri (Rt-mri) Performed In 20 Ibmmentioning

confidence: 99%

“…-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.…”

Section: Detecting Aspiration On Vfssmentioning

confidence: 99%

“…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.…”

Section: Detecting Aspiration On Vfssmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Salam,

Allen,

Dimachkie

et al. 2023

Clinical and Experimental Rheumatology

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Sporadic inclusion body myositis (IBM)is a progressive condition which commonly affects patients aged above 40. IBM does not respond to immunosuppression and no proven treatments are available. Up to 80% of patients develop some degree of swallowing impairment during the disease course. Dysphagia is a source of marked morbidity in IBM and predisposes patients to life-threatening complications such as aspiration pneumonia. The pathophysiology behind dysphagia in IBM is not fully understood. Evidence from imaging demonstrates that impaired swallowing is predominantly underpinned by oropharyngeal deficits. Changes in cricopharyngeal physiology is thought to be an important factor influencing dysphagia in IBM. However, it is unclear whether this is secondary to structural changes within the cricopharyngeus itself or driven by impairment of the muscles promoting pharyngeal clearance. The approach to dysphagia in IBM patients is limited by a lack of validated instruments to reliably assess swallowing function and an absence of effective therapeutic interventions derived from controlled trials targeting dysphagia. Imaging modalities such as the video fluoroscopic swallowing study (VFSS)are commonly used to evaluate dysphagia in IBM. Whilst VFSS is a commonly used technique in clinical practice; cumulative radiation exposure with repeated testing can be a limitation. Alternative imaging techniques could be developed further as outcome measures for assessing swallowing. In this review, we provide an overview of imaging techniques used to assess swallowing and the insight provided from such investigations into the mechanisms behind dysphagia in IBM. We suggest future directions for evaluation and outcome measurement of dysphagia in this population.

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Section: Pathophysiology Of Dysphagia In Ibmmentioning

confidence: 99%

Section: Mri (Rt-mri) Performed In 20 Ibmmentioning

confidence: 99%

Section: Detecting Aspiration On Vfssmentioning

confidence: 99%

Section: Detecting Aspiration On Vfssmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Salam,

Allen,

Dimachkie

et al. 2023

Clinical and Experimental Rheumatology

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Features of Swallowing Function in Sporadic Inclusion Body Myositis: Preliminary Evidence Using Well-Tested Assessment Frameworks

Ambrocio,

Aggarwal,

Lacomis

et al. 2024

Am J Speech Lang Pathol

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Purpose: Evidence surrounding swallowing impairment in sporadic inclusion body myositis (IBM) is based on nonstandardized and nonvalidated assessment methods. We investigated (a) IBM's impact on swallowing function and oral intake status using well-tested assessment frameworks; (b) changes in swallowing over time; and (c) age, sex, and swallowing impairment severity's influence on oral intake status. Method: We conducted a secondary analysis of Modified Barium Swallow Impairment Profile (MBSImP) and Functional Oral Intake Scale (FOIS) data from 13 patients with IBM (seven females; M age = 60.2 [±13.6] years) and 13 age- and sex-matched healthy controls. We compared MBSImP Overall Impression (OI), Oral Total (OT), Pharyngeal Total (PT), and FOIS scores between groups. Specific to the IBM cohort, we analyzed repeated OT and PT scores and calculated whether age, sex, and OT and PT scores predicted FOIS scores. Results: The IBM cohort demonstrated poorer OI scores across six swallowing components than healthy controls (each p < .05). Unlike OT scores ( p = .84), PT ( p = .033) and FOIS ( p < .001) scores were worse in the IBM cohort. Repeated OI scores revealed changes in three swallowing components (each p < .05), but repeated OT ( p = .16) and PT ( p = .30) scores did not significantly change. Age, sex, and OT and PT scores did not influence FOIS scores (each p > .05). Conclusions: Pharyngeal impairments were most prominent in the IBM cohort, and their oral intake status was adversely affected. Our preliminary data showcase the application of robust assessment methods to investigate swallowing function in IBM, enhancing standardization and comparability across studies. Supplemental Material: https://doi.org/10.23641/asha.27165450

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Diagnosing and managing dysphagia in inclusion body myositis: a systematic review

et al. 2023

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Objectives Dysphagia is a common debilitating clinical feature of inclusion body myositis (IBM). However, the impact of dysphagia in IBM has been historically overlooked. This study aimed to identify, evaluate, and summarize the evidence regarding assessment and management of dysphagia in persons with IBM undergoing treatment. Methods A systematic review was conducted using a multi-engine search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Eligible studies had to employ an intervention for persons with IBM, report a swallowing outcome, and be published in English. Quality assessments of the eligible studies were performed. Results Of 239 studies found, 19 met inclusion criteria. One study was rated as “fair” and the rest as “poor” quality, particularly due to the lack of published and validated swallowing assessment procedures and outcome measures. Cricopharyngeal (CP) dysfunction (12/19) was the most commonly reported swallowing abnormality. Interventions for disease management included pharmacological agents (10/19), followed by surgical (3/19), behavioral (1/19), and combined approaches (5/19). Interventions with immunosuppressants, Botox injection, balloon dilation, and/or CP myotomy led to mixed and transient benefit. Few studies examining statins or behavioral therapies (primarily focused on respiratory function) showed no effects for dysphagia. Conclusion Various interventions have been reported to temporarily improve dysphagia in persons with IBM. However, these findings are based on limited and overall low-quality evidence. This study cautions the generalization of these findings and emphasizes the need for further systematic research to improve diagnosis and management of dysphagia in IBM.

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Dysphagia in Inclusion Body Myositis, A Disease of the Elderly

Cited by 3 publications

References 49 publications

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

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

Features of Swallowing Function in Sporadic Inclusion Body Myositis: Preliminary Evidence Using Well-Tested Assessment Frameworks

Diagnosing and managing dysphagia in inclusion body myositis: a systematic review

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