Dysphagia is one of the commonest symptoms of myasthenia gravis. Moreover, it may often be the presenting symptom, some difficulty in swallowing being the first sign of abnormal muscular fatigue. The defect in the swallowing reflex is due to weakness of the buccopharyngeal muscles, usually with relaxation of the constrictors. Both the feeble power of the reflex act, as shown by the slowness of movement, and the relaxation, with dilation of the pharyngeal tube, are easily demonstrated by roentgenoscopic examination. The tightening of these muscles and the increased rate of swallowing, after stimulation by an appropriate amount of neostigmine ("prostigmine") methylsulfate, was observed and recorded in cases of myasthenia gravis by Schwab and Viets1 in 1941. They suggested that this method of examination might be used as a test for the disease, and the present communication is in effect a reinforcement of the observations of 1941 in the light
VIETS HR. DIAGNOSIS OF MYASTHENIA GRAVIS IN PATIENTS WITH DYSPHAGIA. JAMA. 1947;134(12):987–992. doi:10.1001/jama.1947.02880290001001
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