Gastrointestinal Involvement in Sjögren’s
Sjögren’s can affect the ability to chew, swallow, and digest food through a variety of mechanisms. Difficulty swallowing may relate to lack of saliva, dryness of the esophagus, or poor esophageal contractions. Poor digestion may result from impaired secretion of acid by the stomach or digestive enzymes by the pancreas. Absorption of nutrients can be impaired by the presence of a second autoimmune disease, celiac disease, which may occur in patient with Sjögren’s. Testing for gastrointestinal involvement usually requires x-ray studies, endoscopy, and blood tests.
Tips for managing GI symptoms in Sjögren’s:
■ Eat smaller amounts more frequently. Chew as well as possible.
■ Swallowing problems may be related to esophagus muscle inflammation (myositis), dryness, or
nerve dysfunction. Soft foods, olive oil, and coconut water might help.
■ GERD is more common and due to decreased Lower Esophageal Sphincter tone (60% vs 20%
normal). Avoid reclining after a meal; various anti-acids are available.
■ Gastroparesis (delayed gastric emptying) occurs in Sjögren’s (30-70%), and, similar to Diabetes, causes
upper abdominal pain/fullness/nausea. Gastric parietal cells can be destroyed leading to B12 deficiency.
H pylori bacterial infection, if present, can be treated.
■ Small intestine immune attack (Celiac) or bacterial overgrowth can result in abdominal pain,
cramping, bloating. Try a wheat/gluten free diet, or other food group elimination diets. Most
nutrients are absorbed here.
■ The large intestine is where liquid is reabsorbed. Constipation and diarrhea can occur with
Sjögren’s. Increase vegetables. Try magnesium supplement for constipation.
■ The pancreas, which releases digestive enzymes, can have low-level inflammation (20-40%) in
■ Liver – Autoimmune cholangitis (PBC, hallmark mitochondrial Ab) or Hepatitis (smooth muscle Ab)
can occur in Sjögren’s. Hepatitis C virus should always be excluded.
■ A Neurogastroenterology specialist may be an option for persistent GI problems in those
*excerpts courtesy of The Sjögren’s Book and www.sjogrens.org