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Evidence summaries

Treatment of Dysphagia in Long-Term, Chronic Muscle Disease

There is insufficient evidence on the effectiveness of different treatments in the management of dysphagia in chronic muscle disease. Level of evidence: "D"

A Cochrane review [Abstract] 1 included no RCTs that reported the primary outcome of interest, weight gain or maintenance. However, there was one RCT (n=19) that assessed the effect of iv. immunoglobulin (IVIG) on swallowing in inclusion body myositis (IBM). The number of patients with dysphagia was not specified and the reporting of findings from videofluoroscopia was incomplete. The study did report reductions in the time taken to swallow, as measured using ultrasound. There were two other non-randomised studies reporting the effects of long-term IVIG treatment in adults with IBM (n=16) and lip-strengthening exercises in children with myotonic dystrophy type 1 (n=8). Headaches affected two participants treated with long-term IVIG; there were no adverse events associated with lip-strengthening exercises. Both studies found improved outcomes for some patients following the intervention, but neither study specified the number of patients with dysphagia or demonstrated any group-level treatment effect for swallowing function using the outcomes prespecified in this review.

Comment: The quality of evidence is downgraded by indirectness (differences in outcomes), imprecise results (few patients) and study quality (lack of randomisation).

    References

    • Jones K, Pitceathly RD, Rose MR et al. Interventions for dysphagia in long-term, progressive muscle disease. Cochrane Database Syst Rev 2016;2():CD004303. [PubMed]

Primary/Secondary Keywords