Various interventions may temporarily improve, but not completely resolve, dysphagia in individuals with inclusion body myositis (IBM), according to study findings published in Rheumatology.
In a systematic review, researchers compared evidence on the diagnosis and management of dysphagia in patients with IBM undergoing treatment. Tools and procedures to assess swallowing and measures to evaluate and define swallowing were studied. The impact of the intervention on the symptoms and severity of dysphagia was also assessed.
Researchers conducted a multiengine search via PubMed and Ovia through December 2021 to include studies that use an intervention for patients with IBM and reported swallowing outcomes.
Study authors assigned quality ratings of “good,” “fair,” or “poor,” using the National Heart, Lung, Blood, Institute (NHLBI) Study Quality Assessment tools to indicate risk of bias.
For studies that reported age demographics, the mean age was 70.1 years within the pooled sample. The duration of disease varied greatly, ranging from 5 months to 37 years, with an average of 7.7 years.
Of the 239 studies identified, 19 fulfilled inclusion criteria. The study quality varied, with only 1 being rated as “fair,” while all others were rated as “poor.”
The most frequently reported swallowing abnormality was cricopharyngeal dysfunction followed by bolus flow issues. Of 19 interventions for disease management, 10 involved the use of pharmacologic agents, 3 involved surgeries, 1 involved behavioral approaches, and 5 involved a combination of different approaches. The use of immunosuppressants, Botox injection, balloon dilation, and/or cricopharyngeal myotomy did not result in consistent and lasting improvement.
No notable discrepancies in IBM weakness index swallowing scores were observed between patients with IBM who received immunosuppressants (vs those who did not receive any treatment, as per findings from the largest study. Studies focused on respiratory function found no evidence for the effectiveness of statins or behavioral therapies in treating dysphagia.
A limitation of the review was the exclusivity of using articles published in English only, as well as a possible underrepresentation of behavioral interventions due to the exclusion of case studies.
The study authors concluded, “Future investigations are warranted to better define swallowing pathophysiology using more robust assessment methods. Such systematic efforts would inform intervention efficacy and effectiveness and standard clinical care that could decrease early mortality and increase quality of life in persons with IBM.”
Ambrocio KR, Garand KL, Roy B, Bhutada AM, Malandraki GA. Diagnosing and managing dysphagia in inclusion body myositis: a systematic review. Rheumatology. Published online April 28, 2023. doi:10.1093/rheumatology/kead194