Sanei-Moghaddam Ali, Kumar Sanjiv, Jani Piyush, Brierley Charlotte
Department of ENT, Medway Maritime Hospital, London, UK.
BMJ Case Rep. 2013 Jan 22;2013:bcr2012008058. doi: 10.1136/bcr-2012-008058.
Inclusion body myositis is a chronic progressive myopathy which tends not to respond to steroids and immunosuppressive treatments. Dysphagia is more common in this group than other inflammatory myopathies like polymyositis and dermatomyositis. Otolaryngologists are involved in the management of dysphagia in inclusion body myositis. They usually use a combination of cricopharyngeal myotomy, upper oesophageal dilation or botulinum injection to help with the symptoms. Cricopharyngeus myotomy is the preferred treatment in this group and patients tend to be discharged after a short stay in the hospital. However, our experience was completely different from what we expected as a relatively straightforward procedure led to severe morbidity and prolonged hospital admission due to continuous acid reflux and aspiration. We believe that the presence of hiatus hernia led to this problem as the patient's problem resolved completely after her hernia was treated.
包涵体肌炎是一种慢性进行性肌病，通常对类固醇和免疫抑制治疗无反应。与多发性肌炎和皮肌炎等其他炎性肌病相比，吞咽困难在该组中更为常见。耳鼻喉科医生参与包涵体肌炎吞咽困难的管理。他们通常采用环咽肌切开术、食管上段扩张术或肉毒杆菌注射相结合的方法来缓解症状。环咽肌切开术是该组的首选治疗方法，患者通常在短期住院后出院。然而，我们的经验与预期完全不同，因为一个相对简单的手术由于持续的胃酸反流和误吸导致了严重的发病率和延长的住院时间。我们认为食管裂孔疝的存在导致了这个问题，因为患者的问题在疝得到治疗后完全解决了。
