The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis

(1) Background: Dysphagia is a clinical hallmark and part of the current American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) diagnostic criteria for idiopathic inflammatory myopathy (IIM). However, the data on dysphagia in IIM are heterogenous and partly conflicting. The...

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Veröffentlicht in:Journal of clinical medicine 2020-07, Vol.9 (7), p.2150
Hauptverfasser: Labeit, Bendix, Pawlitzki, Marc, Ruck, Tobias, Muhle, Paul, Claus, Inga, Suntrup-Krueger, Sonja, Warnecke, Tobias, Meuth, Sven G, Wiendl, Heinz, Dziewas, Rainer
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container_end_page
container_issue 7
container_start_page 2150
container_title Journal of clinical medicine
container_volume 9
creator Labeit, Bendix
Pawlitzki, Marc
Ruck, Tobias
Muhle, Paul
Claus, Inga
Suntrup-Krueger, Sonja
Warnecke, Tobias
Meuth, Sven G
Wiendl, Heinz
Dziewas, Rainer
description (1) Background: Dysphagia is a clinical hallmark and part of the current American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) diagnostic criteria for idiopathic inflammatory myopathy (IIM). However, the data on dysphagia in IIM are heterogenous and partly conflicting. The aim of this study was to conduct a systematic review on epidemiology, pathophysiology, outcome and therapy and a meta-analysis on the prevalence of dysphagia in IIM. (2) Methods: Medline was systematically searched for all relevant articles. A random effect model was chosen to estimate the pooled prevalence of dysphagia in the overall cohort of patients with IIM and in different subgroups. (3) Results: 234 studies were included in the review and 116 (10,382 subjects) in the meta-analysis. Dysphagia can occur as initial or sole symptom. The overall pooled prevalence estimate in IIM was 36% and with 56% particularly high in inclusion body myositis. The prevalence estimate was significantly higher in patients with cancer-associated myositis and with NXP2 autoantibodies. Dysphagia is caused by inflammatory involvement of the swallowing muscles, which can lead to reduced pharyngeal contractility, cricopharyngeal dysfunction, reduced laryngeal elevation and hypomotility of the esophagus. Swallowing disorders not only impair the quality of life but can lead to serious complications such as aspiration pneumonia, thus increasing mortality. Beneficial treatment approaches reported include immunomodulatory therapy, the treatment of associated malignant diseases or interventional procedures targeting the cricopharyngeal muscle such as myotomy, dilatation or botulinum toxin injections. (4) Conclusion: Dysphagia should be included as a therapeutic target, especially in the outlined high-risk groups.
doi_str_mv 10.3390/jcm9072150
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However, the data on dysphagia in IIM are heterogenous and partly conflicting. The aim of this study was to conduct a systematic review on epidemiology, pathophysiology, outcome and therapy and a meta-analysis on the prevalence of dysphagia in IIM. (2) Methods: Medline was systematically searched for all relevant articles. A random effect model was chosen to estimate the pooled prevalence of dysphagia in the overall cohort of patients with IIM and in different subgroups. (3) Results: 234 studies were included in the review and 116 (10,382 subjects) in the meta-analysis. Dysphagia can occur as initial or sole symptom. The overall pooled prevalence estimate in IIM was 36% and with 56% particularly high in inclusion body myositis. The prevalence estimate was significantly higher in patients with cancer-associated myositis and with NXP2 autoantibodies. Dysphagia is caused by inflammatory involvement of the swallowing muscles, which can lead to reduced pharyngeal contractility, cricopharyngeal dysfunction, reduced laryngeal elevation and hypomotility of the esophagus. Swallowing disorders not only impair the quality of life but can lead to serious complications such as aspiration pneumonia, thus increasing mortality. Beneficial treatment approaches reported include immunomodulatory therapy, the treatment of associated malignant diseases or interventional procedures targeting the cricopharyngeal muscle such as myotomy, dilatation or botulinum toxin injections. (4) Conclusion: Dysphagia should be included as a therapeutic target, especially in the outlined high-risk groups.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm9072150</identifier><identifier>PMID: 32650400</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Antibodies ; Bias ; Biopsy ; Clinical medicine ; Dysphagia ; Epidemiology ; Esophagus ; Inflammation ; Inflammatory diseases ; Meta-analysis ; Musculoskeletal diseases ; Pathophysiology ; Patients ; Population ; Review ; Systematic review</subject><ispartof>Journal of clinical medicine, 2020-07, Vol.9 (7), p.2150</ispartof><rights>2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). 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source PubMed Central Open Access; MDPI - Multidisciplinary Digital Publishing Institute; EZB-FREE-00999 freely available EZB journals; PubMed Central
subjects Antibodies
Bias
Biopsy
Clinical medicine
Dysphagia
Epidemiology
Esophagus
Inflammation
Inflammatory diseases
Meta-analysis
Musculoskeletal diseases
Pathophysiology
Patients
Population
Review
Systematic review
title The Impact of Dysphagia in Myositis: A Systematic Review and Meta-Analysis
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