4.7 Article

Cricopharyngeal bar on videofluoroscopy: high specificity for inclusion body myositis

Journal

JOURNAL OF NEUROLOGY
Volume 268, Issue 3, Pages 1016-1024

Publisher

SPRINGER HEIDELBERG
DOI: 10.1007/s00415-020-10241-7

Keywords

Cricopharyngeal bar; Inclusion body myositis; Videofluoroscopy; Dysphagia; Upper esophagus

Funding

  1. Research Committee of CNS Degenerative Diseases, the Ministry of Health, Labour and Welfare of Japan
  2. Intramural Research Grant for Neurological and Psychiatric Disorders of NCNP [22-Y2, 24-5, 29-10]
  3. Research on Intractable Diseases of Health and Labor Sciences Research Grants
  4. Comprehensive Research on Disability Health and Welfare Grants
  5. Research and Development Grants for Comprehensive Research for Persons with Disabilities
  6. Practical Research Project for Rare/Intractable Diseases from the Japan Agency for Medical Research and Development (AMED), Health and Labor Science Research Grants
  7. Intramural Research Grant for Neurological and Psychiatric Disorders from the NCNP [29-3, 29-4]

Ask authors/readers for more resources

The presence of cricopharyngeal bar (CPB) may indicate inclusion body myositis (IBM). In IBM patients with CPB, the upper esophagus becomes narrow like a bottleneck. This study provides new perspectives on dysphagia diagnosis through videofluoroscopy, particularly for IBM-related dysphagia.
Objective To determine the prevalence and characteristics of the cricopharyngeal bar (CPB), defined as marked protrusion with lacking relaxation and stricture of the upper esophageal sphincter on videofluoroscopy, in patients with inclusion body myositis (IBM). Methods We conducted a case-control study of comprehensive series of adult healthy individuals and consecutive patients with neuropsychiatric disorders aged over 45 (52 versus 2486). A standard videofluoroscopy was performed. Results Overall, 47 individuals with CPB were identified. Of the individuals with CPB, 36% were IBM followed by neurodegenerative disorders, muscular disorders, neuromuscular disorders, and others (32%, 21%, 2.1%, and 8.5%, respectively), indicating the heterogeneity of the etiologies. Against muscular disorders, the sensitivity and specificity of the CPB for IBM were 33% (= 17/52; 95% confidence interval [CI], 20-45%) and 96% (= 264/274; 95% CI, 94-99%), respectively. IBM with CPB showed a higher frequency of obstruction-related dysphagia (88% versus 22%,p < 0.001) and severe CPB (76% versus 23%,p < 0.001) than the control with one. The ratio of the upper esophageal distance at the maximum distension at the level of C6 to that of C4 was lower in IBM with CPB than in the controls with one (0.50 versus 0.77,p < 0.001), which suggests the insufficient opening of the upper esophageal sphincter. Conclusion A CPB could be indicative of IBM. The upper esophagus in IBM with CPB became narrow, like a bottleneck. We provide new perspectives of dysphagia diagnosis by videofluoroscopy, especially for IBM-associated dysphagia, to expand the knowledge on the CPB.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

No Data Available
No Data Available