Autoimmune Neurogenic Dysphagia.
Panos Stathopoulos, Marinos C Dalakas
PMID 34226958WHAT IT FOUND
Dysphagia can be the first sign of an autoimmune neurological disease like myasthenia gravis or inflammatory myopathy.
Early identification allows for immunotherapy, which often resolves swallowing issues. Clinicians should maintain a high suspicion for autoimmune causes when dysphagia presents without a clear neurological history.
Key findings
01Dysphagia can be the sole or first manifestation of an autoimmune neurological disease, and patients may respond to immunotherapies.
02In inclusion body myositis, dysphagia is frequent and disabling, but intravenous immunoglobulin (IVIg) has shown significant improvement in swallowing measures despite no benefit for muscle strength.
03Myasthenia gravis dysphagia, particularly in MuSK-positive cases, is highly treatable with immunotherapies like rituximab, leading to remission.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so it may be subject to selection bias in the studies cited. Prevalence data for dysphagia varies widely depending on whether it was assessed clinically or with instrumental tests like VFSS, which may overestimate or underestimate the true burden in different populations. The review relies on the authors' expert opinion and experience for treatment recommendations and clinical clues, which may not reflect all contemporary guidelines. Many of the cited studies are retrospective, heterogeneous, or small, limiting the strength of evidence for specific prevalence rates and treatment outcomes.
Declared interests
The authors declare no conflicts of interest. The paper is an opinion article reviewing existing literature.
The easy way to misread this
Do not assume all autoimmune dysphagia responds equally to treatment. While myasthenia gravis and dermatomyositis often show dramatic improvement with immunotherapy, inclusion body myositis is notoriously resistant to most immunosuppressants, and IVIg benefits are limited to swallowing measures rather than overall muscle strength. Misidentifying IBM as polymyositis can lead to ineffective treatment and delayed appropriate care.