RESEARCH - Esophageal motor function in primary Sjogren's syndrome: correlation with dysphagia and xerostomia

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Dig Dis Sci. 1997 Jan;42(1):113-8.

Esophageal motor function in primary Sjogren's syndrome: correlation with

dysphagia and xerostomia.

Anselmino M, Zaninotto G, Costantini M, Ostuni P, Ianniello A, Boccu C,

Doria A, Todesco S, Ancona E.

Department of Surgery, University of Padua, School of Medicine, Italy.

The incidence of dysphagia in patients with primary Sjogren's syndrome (pSS)

has been underestimated and all too often ascribed to xerostomia, without

considering the possible presence of esophageal motor abnormalities

affecting other nonscleroderma connective tissue diseases. Esophageal and

salivary functions were prospectively evaluated in 27 females who met the

four criteria proposed by Fox for the diagnosis of pSS, using esophageal

manometry after wet swallows and Saxon's test, respectively. Dysphagia was

graded using a standard symptoms questionnaire and results 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 mild dysphagia, 7 (26%)

had moderate dysphagia, and 11 (40.6%) had severe dysphagia. Saxon's test

revealed an overall decrease in the salivary flow rate compared to controls,

with no difference between patients with or without dysphagia. Esophageal

manometry demonstrated the absence of any lower or upper esophageal

sphincter function abnormalities in all patients. In the patients with pSS

as a whole, manometric study of the esophageal body showed a motor pattern

comparable with that of controls, with no difference between patients with

and without dysphagia. Defective peristalsis, ie, the presence of

simultaneous contractions in more than 30% of wet swallows was detected,

however, in the distal tract of the esophagus of six patients (22.2%) and in

the proximal tract of three (11.1%). All these patients had severe dysphagia

and the modified Saxon's test revealed a salivary secretion comparable with

that of patients with a normal peristalsis. Dysphagia is a very common

complaint in patients with pSS and does not seem to correlate with

xerostomia, which is a constant and typical finding of the disease. About

one third of patients with pSS have an abnormal esophageal peristalsis that

is responsible for severe dysphagia, whereas decreased salivary outflow

exacerbates the swallowing discomfort. This has to be taken into account and

justifies the routine use of esophageal manometry in patients with pSS. The

cause of dysphagia in pSS patients without peristaltic disorders of the

esophagus has to be investigated.

PMID: 9009125

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=9\

009125 & dopt=Abstract

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