title: Gluten sensitivity in patients with primary Sjögren's syndrome.
abstract: OBJECTIVE
  To evaluate the rectal mucosal response to gluten as an indication of gluten sensitivity in patients with primary Sjögren's syndrome (pSS).
  
  
  METHODS
  Rectal challenges with wheat gluten were performed in 20 patients with pSS and 18 healthy control subjects. Fifteen hours after challenge the mucosal production of nitric oxide (NO) was measured.
  
  
  RESULTS
  Five patients with pSS had a significant increase in the luminal release of NO after the rectal gluten challenge, indicating gluten sensitivity. All were HLA-DQ2 and/or -DQ8-positive. Two of the patients with increased NO had antibodies against transglutaminase and a duodenal biopsy showed an absolutely flat mucosa consistent with coeliac disease in one of the patients. Before gluten challenge, 15 of the Sjögren's syndrome (SS) patients reported gastrointestinal symptoms, and 8 reported intolerance to various food products. No correlation was found between gluten sensitivity and self-reported food intolerance or gastrointestinal symptoms.
  
  
  CONCLUSIONS
  Rectal mucosal inflammatory response after gluten challenge is often seen in patients with pSS, signifying gluten sensitivity. However, this reactivity is not necessarily linked to coeliac disease.
authors.affiliation: Department of Medical Sciences Rheumatology, University Hospital, Uppsala, Sweden. maria.liden@medsci.uu.se
authors.forename: Maria
authors.initials: M
authors.lastname: Lidén
authors.forename: Gudjón
authors.initials: G
authors.lastname: Kristjánsson
authors.forename: Sigrídur
authors.initials: S
authors.lastname: Valtýsdóttir
authors.forename: Roger
authors.initials: R
authors.lastname: Hällgren
mesh_terms: D000328:Adult; D000368:Aged; D002446:Celiac Disease / Q000209:etiology*; D005260:Female; D005983:Glutens / Q000276:immunology*; D006801:Humans; D007413:Intestinal Mucosa / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D016111:Sjogren-Larsson Syndrome / Q000150:complications*
chemical_list: D005983:Glutens