Gastrointestinal Involvement in Primary Sjögren’s Syndrome

  • Manuel Ramos-Casals
  • José Rosas
  • Roser Solans
  • Margit Zeher
  • Peter Szodoray


Gastrointestinal involvement in primary Sjögren’s syndrome (pSS) may include altered esophageal motility, gastroesophageal reflux, chronic gastritis and, less frequently, intestinal malabsorption [1–3] (Table 16.1).


Irritable Bowel Syndrome Celiac Disease Pylorus Infection Pylorus Eradication Chronic Gastritis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Fox RI. Sjogren’s syndrome. Lancet. 2005;366:321–31.PubMedCrossRefGoogle Scholar
  2. 2.
    Kassan SS, Moutsopoulos HM. Clinical manifestations and early diagnosis of Sjogren ­syndrome. Arch Intern Med. 2004;164:1275–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Ramos-Casals M, Tzioufas AG, Font J. Primary Sjogren’s syndrome: new clinical and therapeutic concepts. Ann Rheum Dis. 2005;64:347–54.PubMedCrossRefGoogle Scholar
  4. 4.
    Helm JF. Role of saliva in esophageal function and disease. Dysphagia. 1989;4:76–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Anselmino M, Zaninotto G, Costantini M, Ostuni P, Ianniello A, Boccu C, et al. Esophageal motor function in primary Sjogren’s syndrome: correlation with dysphagia and xerostomia. Dig Dis Sci. 1997;42:113–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Grande L, Lacima G, Ros E, Font J, Pera C. Esophageal motor function in primary Sjogren’s syndrome. Am J Gastroenterol. 1993;88:378–81.PubMedGoogle Scholar
  7. 7.
    Volter F, Fain O, Mathieu E, Thomas M. Esophageal function and Sjogren’s syndrome. Dig Dis Sci. 2004;49:248–53.PubMedCrossRefGoogle Scholar
  8. 8.
    Rosztoczy A, Kovacs L, Wittmann T, Lonovics J, Pokorny G. Manometric assessment of impaired esophageal motor function in primary Sjogren’s syndrome. Clin Exp Rheumatol. 2001;19:147–52.PubMedGoogle Scholar
  9. 9.
    Tsianos EB, Chiras CD, Drosos AA, Moutsopoulos HM. Esophageal dysfunction in patients with primary Sjögren’s syndrome. Ann Rheum Dis. 1998;544:610–3.Google Scholar
  10. 10.
    Kjellen G, Fransson SG, Lindstrom F, Sokjer H, Tibbling L. Esophageal function, radiography and dysphagia in Sjögren’s syndrome. Dig Dis Sci. 1986;31:225–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Palma R, Freire A, Freitas J, Morbey A, Costa T, Saraiva F, et al. Esophageal motility disorders in patients with Sjogren’s syndrome. Dig Dis Sci. 1994;39:758–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Mandl T, Ekberg O, Wollmer P, Manthorpe R, Jacobsson LT. Dysphagia and dysmotility of the pharynx and oesophagus in patients with primary Sjögren’s syndrome. Scand J Rheumatol. 2007;36:394–401.PubMedCrossRefGoogle Scholar
  13. 13.
    Kahrilas PJ, Dodds WJ, Hogan WJ, Kern M, Arndorfer RC, Reece A. Esophageal peristaltic dysfunction in peptic esophagitis. Gastroenterology. 1986;91:897–904.PubMedGoogle Scholar
  14. 14.
    Schowengerdt CG. Standard acid reflux testing revisited. Dig Dis Sci. 2001;46:603–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Geatti O, Shapiro B, Fig LM, Fossaluzza V, Franzon R, De Vita S. Radiolabelled semisolid test meal clearance in the evaluation of esophageal involvement in scleroderma and Sjögren’s syndrome. Am J Physiol Imaging. 1991;6:65–73.PubMedGoogle Scholar
  16. 16.
    Fitzgerald RC, Triadafilopoulos G. Esophageal manifestations of rheumatic disorders. Semin Arthritis Rheum. 1997;26:641–66.PubMedCrossRefGoogle Scholar
  17. 17.
    Ho SC, Chang CS, Wu CY, Chen GH. Ineffective esophageal motility is a primary motility disorder in gastroesophageal reflux disease. Dig Dis Sci. 2002;47:652–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Buchanan WW, Cox AG, McG Harden R, Glen AIM, Gray KG. Gastric studies in Sjogren’s syndrome. Gut. 1966;7:351–4.PubMedCrossRefGoogle Scholar
  19. 19.
    Kilpi A, Bergroth V, Konttinen YT, Maury CPJ, Reitamo S, Wegelius O. Lymphocyte infiltration of the gastric mucosa in Sjogren’s syndrome. Arthritis Rheum. 1983;26:1196–200.PubMedCrossRefGoogle Scholar
  20. 20.
    Maury CPJ, Tornroth T, Teppo AM. Atrophic gastritis in Sjogren’s syndrome. Arthritis Rheum. 1985;28:388–94.PubMedCrossRefGoogle Scholar
  21. 21.
    Collin P, Karvonen AL, Korpela M, Laippala P, Helin H. Gastritis classified in accordance with the Sydney system in patients with primary Sjögren’s syndrome. Scand J Gastroenterol. 1997;32:108–11.PubMedCrossRefGoogle Scholar
  22. 22.
    Nardi N, Brito-Zeron P, Ramos-Casals M, Aguilo S, Cervera R, Ingelmo M, et al. Circulating auto-antibodies against nuclear and non-nuclear antigens in primary Sjogren’s syndrome: prevalence and clinical significance in 335 patients. Clin Rheumatol. 2006;25:341–6.PubMedCrossRefGoogle Scholar
  23. 23.
    El Miedany YM, Baddour M, Ahmed I, Fahmy H. Sjogren’s syndrome: concomitant H pylori infection and possible correlation with clinical parameters. Joint Bone Spine. 2005;72:135–41.PubMedCrossRefGoogle Scholar
  24. 24.
    Ramos-Casals M, Font J, Garcia-Carrasco M, Brito MP, Rosas J, Calvo-Alen J, et al. Primary Sjogren syndrome: hematologic patterns of disease expression. Medicine (Baltimore). 2002;81:281–92.CrossRefGoogle Scholar
  25. 25.
    Pedro-Botet J, Coll J, Tomás S, Soriano JC, Gutiérrez Cebollado J. Primary Sjogren’s syndrome associated with chronic atrophic gastritis and pernicious anemia. J Clin Gastroenterol. 1993;16:146–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wegelious O, Fyhrquist F, Adner PL. Sjogren’s syndrome associated with vitamin B12 deficiency. Acta Rheumatol Scand. 1970;16:184–90.Google Scholar
  27. 27.
    Williamson J, Paterson RW, McGavin DD, Greig WR, Whaley K. Sjogren’s syndrome in relation to pernicious anaemia and idiophatic Addison’s disease. Br J Ophthalmol. 1970;54:31–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Sorrentino D, Faller G, DeVita S, Avellini C, Labombarda A, Ferraccioli G, et al. Helicobacter pylori associated antigastric autoantibodies: role in Sjögren’s syndrome gastritis. Helicobacter. 2004;9:46–53.PubMedCrossRefGoogle Scholar
  29. 29.
    Theander E, Nilsson I, Manthorpe R, Jacobsson LT, Wadstrom T. Seroprevalence of Helicobacter pylori in primary Sjogren’s syndrome. Clin Exp Rheumatol. 2001;19:633–8.PubMedGoogle Scholar
  30. 30.
    De Vita S, Ferraccioli G, Avellini C. Widerspread clonal B-cell disorder in Sjogren’s syndrome predisposing to H. pylori related gastric lymphoma. Gastroenterology. 1996;110:1969–74.PubMedCrossRefGoogle Scholar
  31. 31.
    Ostuni PA, Germana B, DiMario F, Rugge M, Plebani M, DeZambiasi P. Gastric involvement in primary Sjogren’s syndrome. Clin Exp Rheumatol. 1993;11:21–5.PubMedGoogle Scholar
  32. 32.
    Sugaya T, Sakai H, Sugiyama T, Imai K. Atrophic gastritis in Sjogren’s syndrome. Nippon Rinsho. 1995;53:2540–4.PubMedGoogle Scholar
  33. 33.
    Witteman EM, Mravunac M, Becx MJ, Hopman WP, Verschoor JS, Tytgat GN, et al. Improvement of gastric inflammation and resolution of epithelial damage one year after eradication of Helicobacter pylori. J Clin Pathol. 1995;48:250–6.PubMedCrossRefGoogle Scholar
  34. 34.
    Ferraccioli GF, Sorrentino D, De Vita S, et al. B cell clonality in gastric lymphoid tissues of patients with Sjogren’s syndrome. Ann Rheum Dis. 1996;55:311–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Illes A, Varoczy L, Papp G, et al. Aspects of B-cell non-Hodgkin’s lymphoma development: a transition from immune-reactivity to malignancy. Scand J Immunol. 2009;69:387–400.PubMedCrossRefGoogle Scholar
  36. 36.
    Iltanen S, Collin P, Korpela M, Holm K, Partanen J, Polvi A, et al. Celiac disease and markers of celiac disease latency in patients with primary Sjogren’s syndrome. Am J Gastroenterol. 1999;94:1042–6.PubMedGoogle Scholar
  37. 37.
    Szodoray P, Barta Z, Lakos G, Szakall S, Zeher M. Coeliac disease in Sjogren’s syndrome – a study of 111 Hungarian patients. Rheumatol Int. 2004;24:278–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Lazarus MN, Isenberg DA. Development of additional autoimmune diseases in a population of patients with primary Sjogren’s syndrome. Ann Rheum Dis. 2005;64:1062–4.PubMedCrossRefGoogle Scholar
  39. 39.
    Garcia-Carrasco M, Ramos-Casals M, Rosas J, et al. Primary Sjogren syndrome: clinical and immunologic disease patterns in a cohort of 400 patients. Medicine (Baltimore). 2002;81:270–80.CrossRefGoogle Scholar
  40. 40.
    Roblin X, Helluwaert F, Bonaz B. Celiac disease must be evaluated in patients with Sjogren syndrome. Arch Intern Med. 2004;164:2387.PubMedCrossRefGoogle Scholar
  41. 41.
    Ramos-Casals M, Anaya JM, Garcia-Carrasco M, et al. Cutaneous vasculitis in primary Sjogren syndrome: classification and clinical significance of 52 patients. Medicine (Baltimore). 2004;83:96–106.CrossRefGoogle Scholar
  42. 42.
    Lidén M, Kristjánsson G, Valtysdottir S, Venge P, Hällgren R. Cow’s milk protein sensitivity assessed by the mucosal patch technique is related to irritable bowel syndrome in patients with primary Sjögren’s syndrome. Clin Exp Allergy. 2008;38:929–35.PubMedCrossRefGoogle Scholar
  43. 43.
    Lidén M, Kristjánsson G, Valtýsdóttir S, Hällgren R. Gluten sensitivity in patients with ­primary Sjögren’s syndrome. Scand J Gastroenterol. 2007;42:962–7.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2011

Authors and Affiliations

  • Manuel Ramos-Casals
    • 1
  • José Rosas
    • 2
  • Roser Solans
    • 3
  • Margit Zeher
    • 4
  • Peter Szodoray
    • 4
  1. 1.Spanish Group of Autoimmune Diseases (GEAS), Spanish Society of Internal Medicine (SEMI), Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune DiseasesICMD Hospital ClínicBarcelonaSpain
  2. 2.Department of RheumatologyHospital de la Vila-JoiosaAlicanteSpain
  3. 3.Department of Internal MedicineHospital Vall d’HebronBarcelonaSpain
  4. 4.Medical and Health Science Center, Clinical Immunology DivisionUniversity of DebrecenDebrecenHungary

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