title: Dysphagia and dysmotility of the pharynx and oesophagus in patients with primary Sjögren's syndrome.
abstract: OBJECTIVE
  To assess the prevalence of pharyngeal and oesophageal symptoms and dysmotility in patients with primary Sjögren's syndrome (pSS) and relate these to autonomic nervous function.
  
  
  METHODS
  Twenty consecutive pSS patients, according to the American-European Consensus Criteria (AECC), and 30 age- and sex-matched controls from the Swedish general population registry were studied. All subjects completed a pharyngeal and oesophageal symptoms questionnaire and were examined by pharyngeal and oesophageal video radiography. In addition, the pSS patients were examined by two different autonomic nervous function tests, the deep breathing test [calculating the expiration/inspiration (E/I) ratio] and the finger skin blood flow test [the vasoconstriction (VAC) index].
  
  
  RESULTS
  pSS patients experienced significantly more dysphagia compared with controls (65% vs. 3%; p<0.001). Pharyngeal (45% vs. 7%; p<0.01), oesophageal (80% vs. 7%; p<0.001) and gastro-oesophageal reflux symptoms (60% vs. 23%; p<0.01) were also more prevalent in pSS patients compared with controls while pharyngeal (15% vs. 17%; p = NS) and oesophageal dysmotility (40% vs. 30%; p = NS) were not. Dysphagia was not associated with dysmotility but was found to be associated with a decreased E/I ratio [-1.05 (-1.51 to -0.40) in patients with dysphagia vs. -0.21 (-0.39 to 0.65) in patients without dysphagia; p<0.01].
  
  
  CONCLUSIONS
  Subjective swallowing difficulties were more common in pSS patients than in controls while objective signs of pharyngeal and oesophageal dysmotility were not. Dysphagia in pSS patients does not seem to be related to video radiographical signs of dysmotility but may be related to an impaired parasympathetic function.
authors.affiliation: Department of Rheumatology, Malmö University Hospital, Malmö, Sweden. thomas.mandl@med.lu.se
authors.forename: T
authors.initials: T
authors.lastname: Mandl
authors.forename: O
authors.initials: O
authors.lastname: Ekberg
authors.forename: P
authors.initials: P
authors.lastname: Wollmer
authors.forename: R
authors.initials: R
authors.lastname: Manthorpe
authors.forename: L T H
authors.initials: LT
authors.lastname: Jacobsson
mesh_terms: D000328:Adult; D017668:Age of Onset; D001341:Autonomic Nervous System / Q000503:physiopathology; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology*; D015154:Esophageal Motility Disorders / Q000209:etiology / Q000503:physiopathology*; D004943:Esophagogastric Junction / Q000503:physiopathology; D004947:Esophagus / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010612:Pharyngitis / Q000209:etiology / Q000503:physiopathology; D010614:Pharynx / Q000503:physiopathology; D012859:Sjogren's Syndrome / Q000150:complications / Q000503:physiopathology*