Understanding Dysphagia in Myasthenia Gravis: Implications and Management Strategies
Myasthenia Gravis (MG) is characterized by fatigable muscle weakness, which can result in otolaryngologic manifestations including dysarthria and dysphagia (Abudalou et al., 2021; Colton-Hudson et al., 2002; Dresser et al., 2021; Gilhus et al., 2016). MG is a rare autoimmune disease which impacts the neuromuscular junction and is characterized by weakness that increases with activity (Garra & Levy, 2025). Differences in the presentation of MG is hypothesized to be due to the variation in immunologic pathogenic origins, leading to the division of MG into subgroups based upon clinical characteristics, immunological markers, population distribution and appropriate treatment (Garra & Levy, 2025; Romi et al., 2017).
Research indicates that many individuals with MG develop dysphagia at some point during the diseases course, and that it can be the presenting symptom, however, dysphagia is typically not the only manifestation (Huang et al., 1988; Klair et al., 2014; Llabrés et al., 2005). Further, MG can impact the respiratory system, in some cases resulting in the need for ventilator support (Klair et al., 2014). Patients with MG may have dysphagia even without the presence of symptoms (Umay et al., 2018). A thorough case history review and clinical swallow evaluation can provide immense value, however, these tools alone are not sufficient to determine the presence and severity of dysphagia secondary to MG (Warnecke et al., 2008).
Research demonstrates that MG can impact swallow safety and efficiency with issues across the continuum including the oral, pharyngeal, and esophageal phases (Colton-Hudson et al., 2002; Klair et al., 2014). Swallowing impairments for those with MG can result in penetration and aspiration - it is important to note that those with MG may present with silent aspiration, demonstrating the importance of the use of flexible endoscopic evaluation (FEES) or a modified barium swallow study (MBSS) (Colton-Hudson et al., 2002; Warnecke et al., 2008). Instrumental evaluations are critical to determine the type and severity of dysphagia in order to reduce the implementation of unnecessary interventions (Abudalou et al., 2021). FEES and MBSS are beneficial in providing early and accurate diagnosis of dysphagia as these tools provide insight into fatigability over the course of consecutive swallowing (Colton-Hudson et al., 2002; Juan et al., 2010).
Intervention to address dysphagia due to MG may include medical management, diet modifications, behavioral techniques, postural techniques, and potentially alternative sources of nutrition and hydration (Juan et al., 2010). Exercises to address strength may be limited due to fatiguability (Colton-Hudson et al., 2022). After medical management of MG has occurred, a follow up instrumental evaluation is warranted in order to make changes to the plan of care as warranted (Juan et al., 2010).
To learn more about dysphagia secondary to MG, we recommend reviewing the articles cited in this post.
