Review article: the gastrointestinal complications of myositis.
BACKGROUND
The inflammatory myopathies are a group of acquired diseases characterized by a proximal myopathy caused by an inflammatory infiltrate of the skeletal muscle. The three major diseases are dermatomyositis, polymyositis and inclusion body myositis.


OBJECTIVE
To review the gastrointestinal manifestations of myositis.


METHODS
Over 110 articles in the English literature were reviewed.


RESULTS
Dysphagia to solids and liquids occurs in patients with myositis. The pharyngo-oesophageal muscle tone is lost and therefore patients develop nasal speech, hoarseness, nasal regurgitation and aspiration pneumonia. There is tongue weakness, flaccid vocal cords, poor palatal motion and pooling of secretions in the distended hypopharynx. Proximal oesophageal skeletal muscle dysfunction is demonstrated by manometry with low amplitude/absent pharyngeal contractions and decreased upper oesophageal sphincter pressures. Patients exhibit markedly elevated creatine kinase and lactate dehydrogenase levels consistent with muscle injury. Myositis can be associated with inflammatory bowel disease, coeliac disease and interferon treatment of hepatitis C. Corticosteroids and other immunosuppressive drugs comprise the mainstay of treatment. Inclusion body myositis responds poorly to these agents and therefore a myotomy is usually indicated.


CONCLUSIONS
Myositis mainly involves the skeletal muscles in the upper oesophagus with dysphagia, along with proximal muscle weakness.
Ebert
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Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA. ebertec@umdnj.edu
D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D018908:Muscle Weakness / Q000150:complications* / Q000503:physiopathology; D018482:Muscle, Skeletal / Q000473:pathology*; D009220:Myositis / Q000150:complications* / Q000175:diagnosis; D010818:Practice Patterns, Physicians'; D011379:Prognosis