Intestinal problems with Sjogrens
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Sjögren’s syndrome is an autoimmune disease where the immune system attacks the glands that make saliva and tears.
This causes the most common symptoms of Sjögren’s syndrome, namely dryness of the eyes and mouth, “siccacomplex". These symptoms often occur in association with other autotimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. When Sjogren's occurs in connection with other diseases like this, it is referred to as secondary Sjogren's syndrome.
Primary Sjögren’s syndrome occurs without other connective tissue diseases.
The major symptoms of Sjögren’s syndrome are a result of inflammation of the secretory glands.
This is also the reason why patients will develop gastrointestinal symptoms. GI symptoms first start as a result of involvement of the salivary glands. Inflammation of the parotid gland - the major salivary gland- causes an under production of saliva and hence a dry mouth.
Other symptoms that reflect under-secretion of saliva include trouble with swallowing, food sticking to the inner surface of the mouth, changes in taste and difficulty speaking. The dryness of the mouth may lead to the development of dental decay as well as bad breath. Superficial infections in the mouth may also occur.
Other problems can develop with the intestines in people with Sjögren’s syndrome. Perhaps most frequently is alteration of large bowel function, leading to abdominal pain and change in bowel habit. It is likely that this is caused by a reduction of intestinal secretions. Rarely the liver can become inflamed with Sjögren’s syndrome.
A reduction in tear production can be confirmed by the performance of a Schirmer’s test, where a small piece of blotting paper is inserted under the lower eyelid for a period of five minutes. The degree of wetness is then measured.
Biopsy of the minor salivary glands of the lower lip can be performed. This is a relatively simple procedure performed under local anesthetic. Characteristic inflammation of the salivary glands is seen pathologically.
A number of different blood tests are helpful in making the diagnosis of Sjögren’s syndrome. This includes a complete blood count, which may show anemia and reduction in white cell count. The erythrocyte sedimentation rate (ESR) test can be elevated and reflects the degree of inflammation occurring. Chemistry studies are usually performed to look for involvement of the liver, the kidneys and muscle.
Abnormal immunological tests are often noted, particularly in primary Sjögren’s syndrome. The ANA test is usually positive and antibodies referred to as SSA and SSB are often abnormally elevated. In addition, abnormalities of the blood proteins can occur causing what is referred to as a polyclonal gammopathy.
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