Inclusion Body Myositis –Treatment

Swallowing

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 swallowing are complicated, and are explained in this video:

Swallowing

If you have dysphagia, everyone you live with should know how to help if you choke. Please read the recommendations from the American Red Cross.

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.

Barium swallow video

Swallowing is sometimes easier in certain head positions, such as the chin-down position.

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 due to stiffness of the muscle, probably because of inflammation and scarring.

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. More severe cases can be treated with a surgical procedure, a cricopharyngeal myotomy, which involves cutting the muscle so it can relax.

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).

Cricopharyngeal dysfunction: Difficulty Swallowing, Especially Solid Foods

Cricopharyngeal dysfunction: Before and After Cricopharyngeal Myotomy

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