Table 2.

GI manifestations of Sjogren’s syndrome

	References	Notes
Mouth
Xerostomia	101,102,103	Included in classification criteria
Dysgeusia	102,103
Dental caries	102,103
Esophagus
Dysphagia	104–109	May relate to oropharyngeal function due to xerostomia, or esophageal dysmotility
Gastro-esophageal reflux disease	104–109
Esophageal dysmotility	104–109
Stomach
Chronic atrophic gastritis	110–113	Up to 81% of patients on EGD
Achlorhydria/Hypopepsinoginemia	114
Intestine
Protein-losing enteropathy	115–119	Rare
Celiac disease	114,120,121	Among those with CD, 3.3% may have SS; among those with SS, up to 14.7% may have CD on biopsy, though lower in cohort studies
Cryoglobulinemic vasculitis		Rare
Pancreas
Pancreatitis	122–125	Often subclinical. Presence of chronic pancreatitis (especially sclerosing) and salivary gland symptoms should raise suspicion for IgG4 related disease.
Pancreatic exocrine insufficiency	126,127	Often subclinical
Liver
Hepatomegaly	128
Abnormal liver enzymes	128–130	Usually mild, low grade. May follow multiple patterns of elevation.
Primary biliary cirrhosis	128–135	Of those with PBC, 18–38% have SS. Of those with SS, 2–7% have positive anti-mitochondrial antibody, and 92% of these patients will have histologic findings of PBC.
Autoimmune hepatitis	136,137	In one study, of those with SS with elevated LFT’s, 47% had AIH on biopsy