*4.9. Oeso-Gastrointestinal Manifestations*

Dysphagia is a frequent complaint in pSS patients generally related to inadequate lubrication of the upper aerodigestive tract and food bolus resulting from hyposalivation. Oesophageal dysmobility is also mentioned in certain cases, explaining the lack of correlation between xerostomia and dysphagia [226,227]. Dyspepsia is frequent, occurring in 23% of pSS patients, and often linked to chronic atrophic gastritis where inflammatory infiltrates similar to those of the SG are found following tissue histological examination. Antibodies against parietal cells or intrinsic factor can be found, but pernicious anaemia remains rare [226]. Manifestations such as diffuse abdominal pain, diarrhoea or malabsorption can occur as part of a protein losing enteropathy or in case of overlap with Celiac disease [226,227]. Interestingly, pSS patients with Primary Biliary Cirrhosis overlap (PBC) are at higher risk of developing duodenal ulcers (85% of cases) [226]. The digestive tract can be the site of acute and serious complications in the context of cryoglobulinaemic vasculitis.
