SAT0286 EVALUATION OF SWALLOWING ALTERATIONS IN PATIENTS WITH IDIOPATHIC INFLAMMATORY MYOPATHIES

Abstract

Background: Dysphagia represents a frequent and disabling symptom in patients with Idiopathic Inflammatory Myopathies (IIMs) and it has been recently included in the new ACR/EULAR classification criteria for IIMs. Despite the clinical relevance, dysphagia assessment in IIMs is not currently standardized and evaluation tools are highly variable between different centers. Functional Endoscopic Evaluation of Swallowing (FESS) is an exam that allows, by using nasal endoscopy, the direct evaluation of anatomic structures and swallowing abilities in different swallowing phase. In fact, FESS could help the identification of different problems leading to dysphagia occurrence and to related dysphagia problems. Thanks to these characteristics, FESS for ENT specialists is the gold standard technique for evaluating swallowing functions. However, no studies so far have investigated the role of FESS in the assessment of IIMs and we are completely lacking a semeiotic description of FESS findings in these patients. Objectives: To provide the first semeiotic description of swallowing alterations evidenced by FEES in a cohort of IIMs patients. Methods: We retrospectively reviewed the FEES findings of IIMs patients performed at our hospital. Results: We enrolled 19 patients with a diagnosis of IIMs (10 patients were positive for a myositis specific antibody), of these 16 (84%) reported symptomatic dysphagia. We divided patients into 3 groups based on levels of peripheral muscle strength. Six patients (32%) had no clinical sign of active muscle disease (MRC scale 5, median CK 51 mU/ml, IQR 35-235), 5 patients (26%) had a mild reduction in muscle strength (MRC scale 4, median CK 76, IQR 54-220) and 8 patients (42%) showed a moderate-severe reduction in muscle strength (MRC scale ≤3, media CK 1440, IQR 628-6180). The 67% of patients without muscle disease activity showed an impairment in the oral phase of swallowing for solids and the 33% for fluids; 33% had a reduction in the activation of the pharyngeal phase of swallowing for both fluids and solids; only 17% of patients showed any sign of penetration, aspiration or pharyngeal residue for both solids and fluids. In the group of patients with moderate muscle activity, 80% of patients showed impairment in the oral phase of swallowing for solids and 40% for fluids; 60% had a reduction in the activation of the pharyngeal phase of swallowing for solids while 40% for fluids; 40% of patients showed signs of penetration, aspiration or pharyngeal residue for both solids and fluids. Finally, in the group of patients with severe muscle disease activity, 88% of patients showed an impairment in the oral phase of swallowing for solids and 50% for fluids; 63% had a reduction in the activation of the pharyngeal phase of swallowing for solids while 50% for fluids; 75% of patients showed signs of penetration, aspiration or pharyngeal residue for both solids and fluids. The 15% of all patients (3 cases, 1 from each group of muscle activity) showed a dysfunction in the upper esophageal sphincter. Of note, 3 patients (15%; 1 with moderate and 2 with severe muscle disease activity) required nutrition through nasogastric tube. Conclusion: We showed that FESS study identified swallowing dysfunctions in both the oral and pharyngeal phases of swallowing. Swallowing dysfunctions were more prevalent in patients with greater muscle involvement; however, alterations were not rare also in patients with no clinical signs of muscle activity and, in particular, in the few patients without reported symptoms of dysphagia. FEES appears as a useful tool for the evaluation of dysphagia in IIMs. Reference [1] Brady S, Otolaryngol Clin North Am. 2013Dec;46(6):1009-22 Disclosure of Interests: Emiliano Marasco: None declared, Giulia Bertino: None declared, Ludovico De Stefano: None declared, Lorenzo Volpiano: None declared, Pietro Canzi: None declared, Marco Benazzo: None declared, Carlomaurizio Montecucco Speakers bureau: AbbVie, Bristol-Myers Squibb, Celgene, Sanofi, Genzyme, Lilly, MSD, Pfizer, UCB, Lorenzo Cavagna: None declared