Proper nutrition is vital to maintaining body function. Everyone needs sufficient carbohydrates, fats, vitamins, minerals, protein, and water. However, for some patients with dermatomyositis (DM), polymyositis (PM) and inclusion body myositis (IBM), getting adequate nutrition is challenging.

Part of this has to do with a complex process that most of us take for granted: swallowing. Normally, when food is swallowed, muscles in the voice box (larynx) tighten to close the top of the trachea (wind pipe) so that food only goes down the esophagus, the tube-like structure that carries food to the stomach. As food is swallowed, muscles in the throat contract to help propel the food downward and insure that none of it is left behind.

About one-third of patients with DM experience problems with swallowing as the disease progressively weakens the muscles that control swallowing. Swallowing problems are more common in patients with PM. About 50 percent of patients with IBM experience problems with swallowing as the disease progresses.

Many of the muscles involved with swallowing are also used for speaking. Speech pathologists has special training in problems associated with these muscles. They are among the specialists who can help you identify strategies to manage problems related to swallowing.

In some cases, a patient may need to have a swallow test to evaluate the problem. A barium swallow radiograph is an X-ray test, in which video is made as you drink barium solutions of varying thickness. Barium allows x-rays to capture on video any swallowing problems that arise.

To overcome swallowing difficulties and continue to meet nutritional needs, you may need to alter your diet. Soft cooked foods are usually easiest to swallow. A speech pathologist can help you identify foods that would be easiest to swallow. In rare cases, you may need to see a dietician to help insure that your nutritional needs are met.

Aspiration is the process of inhaling a foreign substance, a risk that increases with swallowing problems. The major symptom of aspiration is choking or coughing before or after swallowing. However, as many as 50 percent of people with swallowing problems have silent aspirations. This means that they do not cough or choke when they aspirate material.

Certain bacteria live in the mouth, and are harmless as along as they stay there. However, if the same bacteria enter the lungs, they can cause a condition known as aspiration pneumonia. Patients with symptoms of aspiration pneumonia should contact their physician as soon as possible. These symptoms can develop suddenly and may include:

Cough

Chest pain

Fever

Shaking

Chills

Shortness of breath

Rapid breathing and rapid heart rate

Aspiration is most easily managed through prevention. A speech therapist can help a patient identify appropriate strategies to reduce the risk of aspiration. These can include:

Holding the head and chin down while swallowing

Using a thickener product in liquids

Changing the texture and/or temperature of foods

Limiting the amount of food in the mouth at one time

It is also important to maintain good oral hygiene with twice-daily tooth-brushing and flossing. This helps reduce the amount of bacteria in the mouth.

References

First published April 1, 2000
Last updated August 4, 2003
Copyright © 2000 Accordant Health Services, Inc. All Rights Reserved.

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