ISSN:
1573-2568
Keywords:
SJÖGREN'S SYNDROME
;
DYSPHAGIA
;
XEROSTOMIA
;
ESOPHAGEAL MOTILITY
;
ESOPHAGEAL MANOMETRY
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract The incidence of dysphagia in patients withprimary Sjögren's syndrome (pSS) has beenunderestimated and all too often ascribed to xerostomia,without considering the possible presence of esophagealmotor abnormalities affecting other nonsclerodermaconnective tissue diseases. Esophageal and salivaryfunctions were prospectively evaluated in 27 females whomet the four criteria proposed by Fox for the diagnosis of pSS, using esophageal manometry after wetswallows and Saxon's test, respectively. Dysphagia wasgraded using a standard symptoms questionnaire andresults were compared with those obtained in a group of 21 healthy controls. Seven patients with pSS(26%) had no swallowing discomfort, 2 (7.4%) had milddysphagia, 7 (26%) had moderate dysphagia, and 11(40.6%) had severe dysphagia. Saxon's test revealed an overall decrease in the salivary flow ratecompared to controls, with no difference betweenpatients with or without dysphagia. Esophageal manometrydemonstrated the absence of any lower or upperesophageal sphincter function abnormalities in allpatients. In the patients with pSS as a whole,manometric study of the esophageal body showed a motorpattern comparable with that of controls, with nodifference between patients with and without dysphagia.Defective peristalsis, ie, the presence of simultaneouscontractions in more than 30% of wet swallows wasdetected, however, in the distal tract of the esophagus of six patients (22.2%) and in the proximaltract of three (11.1%). All these patients had severedysphagia and the modified Saxon's test revealed asalivary secretion comparable with that of patients with a normal peristalsis. Dysphagia is a verycommon complaint in patients with pSS and does not seemto correlate with xerostomia, which is a constant andtypical finding of the disease. About one third of patients with pSS have an abnormal esophagealperistalsis that is responsible for severe dysphagia,whereas decreased salivary outflow exacerbates theswallowing discomfort. This has to be taken into account and justifies the routine use of esophagealmanometry in patients with pSS. The cause of dysphagiain pSS patients without peristaltic disorders of theesophagus has to be investigated.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1023/A:1018845323765
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