Study of dysphagia in adult patients with myasthenia gravis and its effects on quality of life

Abstract

Abstract Background Myasthenia gravis (MG) is an autoimmune disease that disturbs the transmission of nerve impulses at the neuromuscular junction and can affect swallowing through the involvement of bulbar muscles, resulting in dysphagia. This study aimed to assess swallowing in adult patients with myasthenia gravis to identify the effects of MG on swallowing and quality of life. Methods The study was a prospective cross-sectional study. Adult patients with myasthenia gravis were included, whereas patients with neurological and/or systemic diseases that can affect swallowing were excluded. Swallowing was assessed via bedside clinical assessment, the Dysphagia Handicap Index (DHI), the Swallowing Quality of Life Questionnaire (SWAL-QOL), the Functional Endoscopic Evaluation of Swallowing (FEES), or the Videofluoroscopic Swallowing Study (VFSS). Results The study included 25 patients with a mean age of 39.08 ± 15.60 years. Most of them (92%) successfully passed the water swallow test. With respect to the Dysphagia Handicap Index (DHI) results, 20% had mild dysphagia, 20% had moderate dysphagia, and 12% had severe dysphagia. Some domains of SWAL QOL were affected. With respect to the Yale Pharyngeal Residue Severity Rating Scale, 50% of the patients had mild residue for fluids and solids/semisolids whereas 27.3% and 13.6% of the patients had moderate and severe residue, respectively for solids/semisolids. The penetration aspiration scale results revealed that 27.3% of patients had a PAS of 3 for solids/semisolids. The FEES findings were significantly correlated with the DHI score ( P value 0.008). PAS scores for fluids were significantly correlated with the age of the patients and the age of onset of symptoms ( P values of 0.005 and 0.004, respectively). Conclusions Myasthenia gravis affects swallowing (especially the pharyngeal stage in the form of residue), which can disturb quality of life.