Sjögren's syndrome is an autoimmune inflammatory disorder characterized by the destruction of the salivary and lacrimal glands, resulting in xerostomia and keratocon-junctivitis. Sjögren's syndrome can be a primary disorder or it can present in association with other autoimmune disorders. Autoantibodies anti-Ro and anti-La are found in 60% and 40%, respectively, of patients with Sjögren's. The histologic findings are consistent with the pathophysiology of an autoimmune disease directed at salivary and lacrimal tissue. Classically, a lymphocytic infiltrate is seen with acinar atrophy and hypertrophy of the ductal epithelial cells. Diagnosis is usually made through the biopsy of minor salivary gland tissue in the lower lip. The incidence of dysphagia in these patients has been reported as being anywhere from 32% to 92%. Although the exact mechanism of the dysphagia is unknown, it has been postulated that it is related to the lack of saliva acting as a lubricant. Manometric findings in Sjögren's patients are typically normal. Careful barium esophagrams can detect a subtle proximal esophageal web in up to 10% of patients (17). Treatment is directed at increasing salivary output. See Chapter 2 for further discussion of Sjögren's syndrome.
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