Swallowing Impairments in Patients with Myasthenia Gravis: A Scoping Review

This scoping review aims to describe the oropharyngeal and esophageal swallowing profiles of individuals with Myasthenia Gravis (MG). Given the high prevalence of dysphagia in this population, this review seeks to synthesize existing literature on swallowing impairments and highlight the need for early identification in dysphagia management. This scoping review was conducted in accordance with Joanna Briggs Institute methodology for scoping reviews. Four databases were systematically searched to identify studies that examined swallowing impairments in MG using instrumental assessments. Studies were screened and selected if they utilized instrumental assessments, including Videofluoroscopic Swallowing Study (VFSS), Fiberoptic Endoscopic Evaluation of Swallowing (FEES), and/or esophageal manometry. Included studies were analyzed by two independent reviewers to provide a comprehensive overview of dysphagia across oral, pharyngeal, and esophageal domains using Covidence. A total of 4,305 manuscripts were identified; 1,959 remained after removing duplicates. Following screening titles, abstracts, and full texts, 13 remained. Findings indicate that MG-associated dysphagia affects all domains of swallowing. Disease severity, classified using the Myasthenia Gravis Foundation of America (MGFA) and Osserman classification, was associated with increased dysphagia severity. Studies reported a significant prevalence of silent aspiration, with 75% of silent aspirators developing aspiration pneumonia. This review highlights the high prevalence of dysphagia in MG and the importance of objective assessments in identifying swallowing impairments. Routine instrumental evaluations are essential for managing dysphagia and preventing serious complications such as aspiration pneumonia and myasthenic crisis. Future research should focus on standardizing dysphagia screening and assessment tools for MG.