Manometric assessment of impaired esophageal motor function in primary Sjögren's syndrome.

OBJECTIVE

To evaluate by manometry the esophageal motility changes in patients with primary Sjögren's syndrome (SS).

METHODS

Esophageal manometry was carried out in 25 (F/M: 22/3) primary SS patients with systemic manifestations and in 42 control subjects. The primary SS patients also completed a dysphagia scoring questionnaire and underwent whole salivary flow measurements.

RESULTS

As compared with the controls the primary SS patients exhibited a decreased lower esophageal sphincter (LES) pressure (P < 0.01) and a prolongation of LES relaxations (P < 0.02). In the esophageal body (EB) a decreased peristaltic velocity (p < 0.01), an increased duration of contractions (p < 0.01) and a higher occurrence of simultaneous waves (p < 0.01) were detected. Since decreased peristaltic velocity was the most frequent motor abnormality (11/25 cases), two groups of patients were formed for further analysis: patients with a decreased (group I, n = 11) and patients with a normal (group II, n = 14) peristaltic velocity. The SS patients with a decreased EB propagation velocity (< or = 2.7 cm/s, group I) displayed more significantly decreased pressures (p < 0.01) and more prolonged relaxation times (p < 0.05) in the LES, with higher rates of simultaneous contractions on dry swallows (p = 0.05) in the EB, as compared with those who had a normal peristaltic velocity (group II). Of the clinical parameters, the decreased EB peristaltic velocity was associated with a smaller whole saliva production both in the basal state and after stimulation. Furthermore, this group of patients had a significantly higher liquid requirement for swallowing than those who had normal peristaltic velocities (p = 0.05).

CONCLUSIONS

Primary SS patients with systemic manifestations exhibit several esophageal motility abnormalities. In this study, a decreased EB peristaltic velocity was the most common manometric change, and showed an association with impaired saliva production and higher liquid requirement for swallowing, but not with the laboratory parameters or with the systemic manifestations of the disease.