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Myositis
Published in Jason Liebowitz, Philip Seo, David Hellmann, Michael Zeide, Clinical Innovation in Rheumatology, 2023
The mainstay of treatment is supportive care, and the main goals are to maintain muscle strength and prevent aspirations or falls.13, 118 Increasing evidence favors exercise as a measure to maintain muscle strength and function.119–122 While IBM itself does not affect survival,117 complications of IBM like falls due to quadriceps weakness and aspiration due to dysphagia can increase morbidity. Patient education, evaluation of the home environment by a physical therapist, and speech therapy can be helpful to patients. Dysphagia can be treated as necessary by pharyngoesophageal dilatation or cricopharyngeal myotomy.123
Hypopharynx
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Patrick J. Bradley, Neeraj Sethi
Inadequate cricopharyngeus myotomy is considered to be the major cause for recurrent and/or persistent symptoms. An open cricopharyngeal myotomy alone without excision of pouch has been reported with good results. The open surgical approach is considered a distinct advantage, and performing an extended myotomy better addresses the pathophysiological cause.
Cricopharyngeal Dysphagia
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Cricopharyngeal myotomy as a sole procedure has a role in the treatment of the very small pouch. There remain some indications for pouch excision. The experience of the surgeon appears to be of the utmost importance. At times, pouch surgery can be difficult and the complications life-threatening. Surgeons who have developed an interest in pouch surgery sufficient to publish large series have the best results.
Zenker’s diverticulum treated via per-oral endoscopic myotomy
Published in Baylor University Medical Center Proceedings, 2020
Ahmed Ebrahim, Steven G. Leeds, Jessica S. Clothier, Marc A. Ward
The cricopharyngeus muscle is the major component of the upper esophageal sphincter.2 Cricopharyngeal dysfunction can lead to a range of disorders, from mild halitosis to dysphagia and aspiration. Common complications of open myotomy in the treatment of ZD include fistula formation and recurrent nerve injury. Patients with ZD also tend to be elderly and may have medical comorbidities that preclude open surgery. Balloon dilation for symptomatic treatment of these patients has been trialed, though with limited success.3 Another common approach is known as trans-oral stapled diverticulectomy. This has the drawbacks of poor visualization due to the large size of the stapler relative to the oral cavity, which can result in a residual pouch due to poor technique. Endoscopic cricopharyngeal myotomy offers lower rates of mortality and complications in the treatment of ZD. In conclusion, Z-POEM is an efficacious first-line treatment for ZD.
Advances in emerging therapeutics for oculopharyngeal muscular dystrophy
Published in Expert Opinion on Orphan Drugs, 2018
Pradeep Harish, George Dickson, Alberto Malerba
OPMD is not generally associated with a reduced life expectancy although it worsens with the age and generally impairs the quality of life of the patients. However, death can occur and the main causes are complications in muscles of the pharyngeal and cricopharyngeal area with choking, malnutrition, or food aspiration leading to pneumonia [33]. Currently, no cure is available for OPMD. Surgical techniques are used to correct ptosis, and cricopharyngeal myotomy is generally performed to reduce the symptoms of dysphagia. However, while this approach improves the opening of the upper oesophageal sphincter, it does not improve the muscle contractility and also a risk of recurrence exists [34]. Other approaches have been tested and include repeated injections of botulinum toxin [35] and cricopharyngeal dilation [36]. Of particular note, cricopharyngeal dilatation can be performed as an outpatient procedure, and studies have indicated safety and patient tolerability for repeating the procedure over multiple years to alleviate dysphagic symptoms, and maintain capability to feed orally [36,37]. However, more studies are needed to prove the efficacy in the long term of these medical approaches. So far, no resolutive treatments for OPMD have been discovered, but a number of potentially promising pharmacological and genetic approaches are in preclinical development and under clinical test in human. Here we review these therapeutics and we discuss their potential as future treatments for OPMD.
Effectiveness of IVIG and balloon dilation combination therapy for refractory dysphagia in anti-TIF1-γ antibody-positive dermatomyositis
Published in Modern Rheumatology Case Reports, 2018
Akira Utsunomiya, Haruka Koizumi, Shiro Iino, Wataru Takashima, Atsushi Tokuriki, Takahiro Tokunaga, Namiko Kobayashi, Yasuhito Hamaguchi, Minoru Hasegawa
Balloon dilatation has become a common method for the treatment of gastrointestinal tract strictures, and it is particularly effective in oesophageal conditions. While balloon dilatation therapy is a simple and low-cost method, there are only a few reports that have demonstrated its utility for pharyngeal dysphagia in polymyositis/dermatomyositis patients [10,11]. Balloon dilatation should be considered in addition to immunosuppressive treatments and rehabilitation of swallowing at an early stage in cases with dysphagia. Especially, we should consider adaptation of these therapy in high-risk patients such as elderly patients, anti-TIF-1γ antibody-positive patients and patients with findings of saliva retention and aspiration by endoscopy and VFSS. The balloon dilatation therapy is helpful to stretch the stiff cricopharyngeal muscle and expand constricted oesophageal orifice physically. In our case, pharyngeal endoscopy and VFSS revealed that the movement of larynx and the passage of swallowed material at oesophageal orifice was improved and saliva retention in the piriform recess was decreased after balloon dilatation. Cricopharyngeal myotomy was also considered in this case, but this therapy is highly invasive. Therefore, we selected the balloon dilatation therapy. Nonetheless, we cannot deny the possibility that the improved dysphagia may be due to the repetitive IVIG. Therefore, our results suggest that combination therapy with IVIG and balloon dilatation can be an optional treatment for refractory dysphagia in dermatomyositis.