Ebert EC
Review article: gastrointestinal complications of myositis. [JOURNAL ARTICLE]
Aliment Pharmacol Ther 2009 Nov 3.
Abstract
Background: The inflammatory myopathies are a group of acquired diseases characterized by a proximal myopathy due to an inflammatory infiltrate of the skeletal muscle. The three major diseases are dermatomyositis, polymyositis, and inclusion body myositis (IBM).
Aims: This review focuses on the gastrointestinal manifestations of myositis.
Methods: Over 110 articles in the English literature were reviewed.
Results: Dysphagia to solids and liquids occurs in patients with myositis. The pharyngoesophageal muscle tone is lost so patients develop nasal speech, hoarseness, nasal regurgitation, and aspiration pneumonia. There is tongue weakness, flaccid vocal cords, poor palatal motion, and pooling of secretions in the distended hypopharynx. Proximal esophageal skeletal muscle dysfunction is demonstrated by manometry with low amplitude/absent pharyngeal contractions and decreased upper esophageal sphincter pressures. Patients exhibit markedly elevated creatine kinase and lactate dehydrogenase levels consistent with muscle injury. Myositis can be associated with inflammatory bowel disease, celiac disease, and interferon treatment of hepatitis C. Corticosteroids and other immunosuppressive drugs comprise the mainstay of treatment. IBM responds poorly to these agents so a myotomy is usually indicated.
Conclusion: Myositis mainly involves the skeletal muscles in the upper esophagus with dysphagia along with proximal muscle weakness.
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