ESOPHAGEAL MOTOR FUNCTION IN PRIMARY SJOGRENS-SYNDROME - CORRELATION WITH DYSPHAGIA AND XEROSTOMIA

The incidence of dysphagia in patients with primary Sjogren's syndrome (pSS) has been underestimated and all too often ascribed to xerostomi a, without considering the possible presence of esophageal motor abnor malities affecting other nonscleroderma connective tissue diseases. Es ophageal and salivary functions were prospectively evaluated in 27 fem ales who met the four criteria proposed by Fox for the diagnosis of pS S, using esophageal manometry after wet swallows and Saxon's test, res pectively. Dysphagia was graded using a standard symptoms questionnair e and results were compared with those obtained in a group of 21 healt hy controls. Seven patients with pSS (26%) had no swallowing discomfor t, 2 (7.4%) had mild dysphagia, 7 (26%) had moderate dysphagia, and 11 (40.6%) had severe dysphagia. Saxon's test revealed an overall decrea se in the salivary flow rate compared to controls, with no difference between patients with or without dysphagia. Esophageal manometry demon strated the absence of any lower or upper esophageal sphincter functio n abnormalities in all patients. In the patients with pSS as a whole, manometric study of the esophageal body showed a motor pattern compara ble with that of controls, with no difference between patients with an d without dysphagia. Defective peristalsis, ie, the presence of simult aneous contractions in more than 30% of wet swallows was detected, how ever, 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 eso phageal 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 esophag eal manometry in patients with pSS. The cause of dysphagia in pSS pati ents without peristaltic disorders of the esophagus has to be investig ated.