Quantitative assessment of dysphagia in patients with primary and secondary Sjögren's syndrome

doi:10.1016/S1079-2104(05)80224-0

Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology

Volume 79, Issue 3, March 1995, Pages 305-310

https://doi.org/10.1016/S1079-2104(05)80224-0 Get rights and content

Dysphagia is a common complaint from patients with salivary gland dysfunction. The purpose of this study was to assess and compare dysphagia in two patient groups with salivary gland dysfunction (primary Sjögren's syndrome and secondary Sjögren's syndrome with systemic lupus erythematosus, and a matched control group. Subjects diagnosed with primary Sjögren's syndrome (n=13) and secondary Sjögren's syndrome with systemic lupus erythematosus (n=15) were selected for the study. An age- and sex-matched group of control subjects (n=14) was selected for comparison. Dysphagia assessments, including videofluoroscopy were performed. Dysphagia was quantified clinically and videofluoroscopically by measurement of 10 seconds of basal or dry swallows as compared with 10-second 10-ml water bolus swallows in all subjects. Subjective evaluations were recorded on a calibrated 10-cm visual analog scale. The results indicated a significant difference in the dry swallows as compared with the water bolus swallows for both salivary gland dysfunction groups and for both dry swallows and water bolus swallows as compared to controls. Videofluoroscopy yielded significantly prolonged pharyngeal transit times in both salivary gland dysfunction groups as compared with control. Subjective results indicated a greater degree of dysphagia symptoms in both the salivary gland dysfunction groups (p<0.001). Conclusions from this study indicate clinically significant dysphagia in patients with salivary gland dysfunction associated with Sjögren's syndrome compared with a control population.

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However, they used ultrasound to measure hyoid bone motion and did not observe the bolus flow directly with videofluoroscopy (VFL). Rhodus et al. [43] also compare patients with Sjögren's syndrome with healthy controls, and use VFL to measure timings for basal swallows (no bolus) and 10 ml water bolus swallows. However, their study did not use barium as a contrast agent and therefore does not observe the bolus directly.
Computer simulation of liquid bolus flow is used to test the assumption that a slip boundary condition approximates a healthy swallow due to the presence of saliva lubricating the bolus. Six dynamic, 320-row area detector CT (ADCT) sequences of normal subjects swallowing thin, nectar, and honey-thick liquids are used in this work. The aerodigestive tract is segmented from the images in order to create a dynamic 3D geometry, which is subsequently used to drive a Smoothed Particle Hydrodynamics (SPH) fluid simulation of the bolus. The results show that the no-slip simulation, approximating no-lubrication, provides a closer match to the ADCT bolus images than the slip simulation, particularly in the oral phase. This finding suggests that the role of saliva in swallowing liquid boluses is not to lubricate the aerodigestive tract, and that there is another reason for its importance in normal swallowing of liquids.
Is it Sjögren's syndrome or burning mouth syndrome? Distinct pathoses with similar oral symptoms
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Patients with SS may demonstrate oral disease manifestations that result primarily from salivary hypofunction, including dental caries and, less commonly, burning mouth secondary to fungal infection.84 Patients may also exhibit difficulty speaking and report dysphasia and dysgeusia.84-86 Patients with SS often demonstrate reduced salivary flow.59
Sjögren's syndrome (SS) and burning mouth syndrome (BMS) typically occur in postmenopausal women. Although these conditions have significantly different etiopathogeneses, patients with SS or BMS often present with analogous oral complaints. The similarities between the two conditions have led to considerable confusion on the part of medical and dental practitioners, and those with BMS or SS often wait years to receive a diagnosis. Therefore, it is imperative for clinicians to understand the characteristic subjective and objective features of each disease and how these can be used to distinguish them. This review will discuss the proposed etiology, clinical manifestations, histopathology, diagnostic criteria, and patient management of SS and BMS. We also identify key differences between the two pathoses that aid in establishing the correct diagnosis. Recognition of the defining features of each condition will lead to reduced time to diagnosis and improved patient management for these poorly understood conditions.
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Both generic and oral health–related QOL were poor in these patients. Specifically, the findings indicated that salivary flow rate was correlated significantly with both Disease Damage Index and OHIP-14 ratings, the number of autoimmune symptoms was correlated significantly with both oral and generic QOL, and oral health accounted for a significant percentage of variance in SF-36 domains of general health and social function.
Oral health appears to have an independent influence on general QOL in patients with SS. These findings underscore the importance of proactive dental management of the oral manifestations of SS.
Dentists and physicians must work collaboratively to maintain oral health and quality of life for patients with Sjögren syndrome. The dentist should address patients' concerns of xerostomia and hyposalivation in an aggressive manner.
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^*: Supported by the Minnesota Clinical Dental Research Center grant number NIH-NIDR DE 09737

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Quantitative assessment of dysphagia in patients with primary and secondary Sjögren's syndrome*

Oral Surg Oral Med Oral Pathol

Am J Med

Otolaryngol Clin North Am

Otolaryngol Clin North Am

J Am Diet Assoc

Evaluation of stimulated parotid saliva flow rate in different age groups

J Dent Res

Whole-salivasecretion rates in old and young healthy subjects