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.
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REFERENCES
Prause JU, Manthorpe R, Oxholm P, Schiodt M: Definition and criteria for Sjögren's syndrome used by the contributors to the First International Seminar on Sjögren's syndrome 1986. Scand J Rheumatol (Suppl) 61:17–18, 1986
Tsianos EB, Vasakos S, Dros AA, Malamou-Mitsi VD, Moutsopoulos HM: The gastrointestinal involvement in primary Sjögren's syndrome. Scand J Rheumatol (Suppl) 61:151–155, 1986
Tsianos EB, Chiras CD, Drosos AA, Moutsopoulos HM: Oesophageal dysfunction in patients with primary Sjögren's syndrome. Ann Rheum Dis 44:610–613, 1985
Sonies BC, Ship JA, Baum BJ: Relationship between saliva production and oropharyngeal swallow in healthy, differentaged adults. Dysphagia 4:85–89, 1989
Helm JF: Role of saliva in esophageal function and disease. Dysphagia 4:76–84, 1989
Ramirez-Mata M, Reyes PA, Alarcon-Segovia D, Garza R: Esophageal motility in systemic lupus erythematosus. Am J Dig Dis 19:132–136, 1974
Horowitz M, McNeil JD, Maddern GJ, Collins PJ, Shearman DJ: Abnormalities of gastric and esophageal emptying in polymyositis and dermatomyositis. Gastroenterology 90:434–439, 1986
Doria A, Bonavina L, Anselmino M, Ruffatti A, Favaretto M, Gambari PF, Peracchia A, Todesco S: Esophageal involvement in mixed connective tissue disease. J Rheumatol 18:685–690, 1991
Ramirez-Mata M, Pena-Ancira FF, Alarcon-Segovia D: Abnormal esophageal motility in primary Sjögren's syndrome. J Rheumatol 3:63–69, 1976
Grande L, Lacima G, Ros E, Font J, Pera C: Esophageal motor function in primary Sjögren's syndrome. Am J Gastroenterol 88:378–381, 1993
Kjellen G, Fransson SG, Lindstrom F, Sokjer H, Tibbling L: Esophageal function, radiography, and dysphagia in Sjögren's syndrome. Dig Dis Sci 31:225–229, 1986
Fox RI, Robinson CA, Curd JG, Kozin F, Howell FV: Sjögren's syndrome: Proposed criteria for classification. Arthritis Rheum 29:577–585, 1986
Zaninotto G, Costantini M, Anselmino M, Boccú C, Bagolin F, Polo R, Ancona E: Excessive competence of the lower oesophageal sphincter after Nissen fundoplication: Evaluation by three-dimensional computerised imaging. Eur J Surg 161:241–246, 1995
Zaninotto G, DeMeester TR, Schwizer W, Johansson K-E, Cheng SC: The lower esophageal sphincter in health and disease. Am J Surg 155:104–111, 1988
Schirmer O: Studien zur Physiologie und Pathologie der Tranenabsorderung und Tranenabfulis. Albrecht von Graefes. Arch Clin Exp Ophthalmol 56:197–221, 1903
Kohler PF, Winter ME: A quantitative test for xerostomia. The Saxon test, an oral equivalent of the Schirmer test. Arthritis Rheum 28:1128–1132, 1985
Ostuni PA, Gazzetto G, Andretta M, Zucchetta P, Ianniello A, Sfriso P, Gambari PF: Il test di Saxon nella valutazione della componente salivare della sindrome di Sjögren. Reumatismo 44:103–113, 1992
Chisholm DM, Mason DK: Labial salivary gland biopsy in Sjögren's disease: J Clin Pathol 21:656–660, 1968
Skopouli FN, Siouna-Fatourou HI, Ziciadis C, Moutsopoulos HM: Evaluation of unstimulated whole saliva flow rate and stimulated parotid flow as confirmatory tests for xerostomia. Clin Exp Rheumatol 7:127–131, 1989
Doig JA, Whaley K, Dick WC, Nuki G, Williamson J, Buchanan WW: Otolaryngological aspects of Sjögren's syndrome. Br Med J 4:460–463, 1971
Caruso AJ, Sonies BC, Atkinson JC, Fox PC: Objective measures of swallowing in patients with primary Sjögren's syndrome. Dysphagia 4:101–105, 1989
Jones B, Ravich WJ, Donner MW: Dysphagia in systemic disease. Dysphagia 8:368–383, 1993
Hughes CV, Baum BJ, Fox PC, Marmary Y, Yeh C-K, Sonies BC: Oral-pharyngeal dysphagia: A common sequela of salivary gland dysfunction. Dysphagia 1:173–177, 1987
Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL III, Castell JA, Castell DO: Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci 32:583–592, 1987
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Anselmino, M., Zaninotto, G., Costantini, M. et al. Esophageal Motor Function in Primary Sjögren's Syndrome Correlation with Dysphagia and Xerostomia. Dig Dis Sci 42, 113–118 (1997). https://doi.org/10.1023/A:1018845323765
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DOI: https://doi.org/10.1023/A:1018845323765