Dysphagia as an Early Presenting Symptom in Dermatomyositis

Adeputri Tanesha Idhayu, Marcellus Simadibrata, Gerie Amarendra

Research output: Contribution to journalArticlepeer-review

Abstract

Dermatomyositis is a systemic disorder that frequently affects the esophagus, lungs, and the heart. Dermatomyositis diagnostic criteria involve evaluation of proximal muscle weakness, elevation serum levels of muscle enzyme, characteristic features of electromyography, typical muscle biopsy and classical skin rash of dermatomyositis. The prevalence of dysphagia in patients with dermatomyositis varied from 10-73%. A 40-year-old male was admitted to Cipto Mangunkusumo hospital with chief complaint of difficult in swallowing. He had been well until he began to have muscle weakness, myalgia, fatigue, and obstructive symptom in his upper digestion tract. Physical examination showed general weakness and symmetrical rash on the face, chest and back. Laboratory examination revealed anemia, thrombocytopenia, and elevated transaminase serum level. Antinuclear antibody was positive. Esophagogastroduodenoscopy showed severe esophagitis. The gastric mucosa biopsy revealed non-active chronic gastritis, antral lymph atrophy, and non-dysplastic. Biopsy of esophageal mucosa showed Barret’s esophagus with squamous epithelial cell and hard dysplasia focus. The electromyography result was suspected to a dermatomyositis. The deltoid muscle biopsy demonstrated dystrophy. Dysphagia may be an initial presenting symptom and especially prevalent in patients with dermatomyositis or other inflammatory myopathy. Dysphagia associated with these myopathies primarily affects the skeletal muscle–activated oropharyngeal phase of swallowing. It may precede weakness of the extremities or present as the sole symptom. Recommended treatments used to treat inflammatory myopathy associated dysphagia are combination of medical, rehabilitation, and interventional. Dysphagia associated with nutritional deficits, aspiration pneumonia, decreased quality of life, and poor prognosis. Patients with inflammatory myopathy and dysphagia are reported to have a 1-year mortality rate of 31%.
Original languageEnglish
JournalThe Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy
Publication statusPublished - 2011

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