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Esophageal high-resolution manometry. Esophageal highresolution manometry showed high integrated relaxation pressure, low distal contractile integral, and normal lower esophageal sphincter pressure; an absence of peristalsis in the esophagus was demonstrated. LES, lower esophageal sphincter; UES, upper esophageal sphincter; WS, wet swallow.
Context in source publication
Context 1
... showed weak pharyngeal pressure (25.2 6 9.8 mm Hg; normal mean 5 71.7 mm Hg), slow pharyngeal velocity to the upper esophageal sphincter (1.2 6 1.7 cm/s; normal mean 5 3.5 cm/s), and positive upper esophageal sphincter relaxation pressure (4.7 6 7.9 mm Hg; normal mean 5 -6.11 mm Hg), all of which indicated pharyngeal dysmotility (Figure 1). 1,2 Esophageal HRM showed high integrated relaxation pressure (16.8 6 6.6 mm Hg; normal mean 5 6 mm Hg), low distal contractile integral (103.7 6 52.4 mm Hg-cm-s; normal mean 5 1868.25 mm Hg-cm-s), normal lower esophageal sphincter pressure (26.8 6 4.4 mm Hg; normal mean 5 18.95 mm Hg), and absence of peristalsis in the esophagus (Figure 2). 2 Sporadic IBM (sIBM) is a chronic progressive muscular disorder that develops in people aged 50 years and older. ...
Citations
... Manometry. Another tool that has been used to investigate dysphagia in IBM patients is pharyngoesophageal manometry (3,11,16,40,68). It is primarily used to assess contraction of the pharyngeal muscles plus resting and relaxation pressures of the UES during oropharyngeal swallowing. ...
... High resolution oesophageal manometry (HRM) has been implemented in clinical practice and research in recent years (70). A case report described the use of HRM in an IBM patient, revealing findings similar to those described by Murata et al. (40,68). This patient demonstrated reduced pharyngeal pressures and elevated UES relaxation pressures.(68) ...
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.
... Manometry is another valuable diagnostic tool which can measure pharyngeal and esophageal pressures and should strongly be considered when upper esophageal dysfunction is observed on another instrumental method or when previous diagnostic work-up was unremarkable despite persistent, progressive dysphagia [18]. We agree with Zeng and Schmidt [7] that manometry should be a companion ...
Purpose of review
Dysphagia is a common symptom of sporadic inclusion body myositis (IBM), affecting disease trajectory and patient quality-of-life. Despite this, it is considerably understudied. The purpose of this review is to summarize current evidence related to the evaluation and management of dysphagia in IBM. We highlight a patient case involving a multidisciplinary management approach, and we encourage continued exploration of exercises for delaying progression and improving impairments in patients with IBM and dysphagia.
Recent findings
Recent investigations confirm that dysphagia in IBM is a debilitating and complex symptom that warrants timely evaluation and management. Further, they highlight the lack of validation of standardized swallowing-related metrics specifically for IBM and the limited evidence supporting a consensus of management approaches. Small scale research and clinical anecdotal data support a multidisciplinary and multipronged patient-centered approach, including rehabilitative exercise protocols, for dysphagia management in IBM.
Summary
A paucity exists in the literature to effectively guide clinical decision-making for patients with IBM and dysphagia. Given this, it is our belief that a careful multidisciplinary and multipronged patient-centered approach is critical for dysphagia management in IBM. Prospective, longitudinal research on the underlying mechanisms of swallowing dysfunction using advanced and validated swallowing-related outcome measures is urgently needed.
