Inclusion Body Myositis – Dysphagia, or Difficulty Swallowing
The Significance of Dysphagia in IBM
Inclusion body myositis patients with dysphagia, or swallowing difficulties, can suffer from poor nutrition as well as choking. Aspiration occurs when food or liquid enters the airway, potentially causing pneumonia. Dysphagia may also promote social isolation, since many of our personal interactions are centered around meals.
The Mechanics of Normal Swallowing
The mechanics of swallowing are complicated, and are explained in this video:
Video of Swallowing Mechanics
Family and Friends Should Know How to Assist in a Choking Emergency
If you have dysphagia, everyone you live with should know how to help if you choke. They should learn the recommended ways to assist in a choking emergency.
American Red Cross summary of choking first aid (printable, one page PDF)
How is Swallowing Evaluated?
Swallowing is evaluated by speech therapists who have expertise in swallowing.
A VideoFluoroscopic Swallowing Study (VFSS), also called a modified barium swallow, may be ordered. The patient swallows a substance called barium that blocks x-rays. During swallowing, x-rays allows the throat to be seen on a video monitor, and the passage of barium from the mouth down into the stomach is observed.
A Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is done by inserting a camera-equipped tube through the nose into the throat so that swallowing can be viewed.
Video of Barium swallow
Causes of Dysphagia in Inclusion Body Myositis
Cricopharyngeus muscle dysfunction is often responsible for swallowing difficulties. The cricopharngeus muscle, located in the upper throat, is also known as the upper esophageal sphincter. It relaxes during normal swallowing, opening up the esophagus so food can pass. Cricophyngeus problems in IBM are often due to stiffness of the muscle, probably because of inflammation and scarring.
Video of Cricopharyngeal dysfunction
Treatment of Dysphagia in IBM
Swallowing is sometimes easier in certain head positions, such as the chin-down position.
It may become necessary to restrict the diet to certain types of food, and eventually to pureed foods. Surprisingly, thin liquids like water may be more difficult to swallow than thicker liquids. Special thickening agents can be added to liquids to make swallowing easier.
Swallowing exercises are sometimes prescribed to try to strengthen the swallowing muscles.
Balloon dilation is the standard treatment for narrowing of the esophagus due to cricopharyngeal dysfunction. In this procedure a special deflated balloon is passed into the esophagus, the swallowing tube in the throat. The balloon is then inflated, expanding and stretching the esophagus. Although the results are usually temporary, and the procedure may need to be repeated, the procedure is very helpful for many people.
Severe cases can be treated with a surgical procedure, a cricopharyngeal myotomy, which involves cutting the muscle so it can relax.
Video of Cricopharyngeal dysfunction: Before and After Cricopharyngeal Myotomy
Finally, if nothing else works, a feeding tube can be placed through the abdominal skin into the stomach using a procedure called a percutaneous endoscopic gastrostomy (PEG).
Video of Feeding Tube Procedure
by Kevin Dooley, MD
Revised December 16, 2019
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