title: Dysphagia as the sole manifestation of myasthenia gravis.
abstract: Three patients are described who had dysphagia as the sole manifestation of myasthenia gravis. Severity ranged from the need to be fed by nasogastric tube to moderate dysphagia requiring only diet change. Oesophageal manometry was carried out in two patients and showed generalised weakness of peristaltic contractions which included the smooth muscle part of the oesophagus. These disturbances worsened with repeated swallows. They were partly reversed by intravenous edrophonium and by rest. Repetitive nerve stimulation was normal in all three patients, but stimulated single fibre EMG of the frontalis muscle showed that all had impairment of neuromuscular transmission. Anti-AChR antibodies were found in only one patient. The most affected patient was treated with pyridostigmine, plasmapheresis, and high dose prednisone. The remaining two patients received only oral anticholinesterases.
authors.affiliation: Servei de Neurologia, Hospital Universitari Son Dureta, C/. Andrea Doria 55, 07014 Palma de Mallorca, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Llabrés
authors.forename: F J
authors.initials: FJ
authors.lastname: Molina-Martinez
authors.forename: F
authors.initials: F
authors.lastname: Miralles
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000209:etiology*; D004576:Electromyography; D004947:Esophagus / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D009130:Muscle, Smooth / Q000502:physiology; D009157:Myasthenia Gravis / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D012720:Severity of Illness Index