The Link Between Celiac Disease and Sjogren's Syndrome

Gluten free brownies on a plate

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Lots of people with celiac disease also have a diagnosis of Sjögren's syndrome, a condition that causes dry eyes and a dry mouth.

As it turns out, there is a connection between the two diseases. Studies show that up to 15% of people diagnosed with Sjögren's syndrome also have the biopsy-proven celiac disease, making it far more common in Sjögren's patients than it is in the general population.

But as with celiac disease and other autoimmune diseases, it's not clear exactly why celiac and Sjögren's occur together frequently. It may be that they share common genetic roots, making a person with one more likely to get the other, as well. Or, it may be that there's a common trigger—possibly gluten, but that's far from proven—involved in both.

Sjögren's Syndrome Involves Autoimmune Attack

When you have celiac disease, your immune system mistakenly attacks the villi in your small intestine, leading to villous atrophy. When you have Sjögren's syndrome, meanwhile, the attack from your immune system takes place in the moisture-producing glands that serve your eyes and your mouth.

People with Sjögren's syndrome may encounter difficulty swallowing, damage to their teeth due to a lack of saliva, and damage to their eyes due to a lack of moisture.

There's no cure for Sjögren's, but it's possible to manage the symptoms with artificial tears, frequent water drinking or gum chewing, or possibly prescription medications that stimulate saliva flow. Physicians recommend using moisturizers to treat the dry skin that frequently comes with Sjögren's, and women can use vaginal lubricants if they have vaginal discomfort due to the condition.

Sjögren's Patients May Be Silent Celiacs

In some cases, people with Sjögren's syndrome who also have celiac disease have silent celiac disease, in which they don't notice medical symptoms but still have intestinal damage.

In one study, some 12% of Sjögren's patients had tTG-IgA antibodies, indicating a strong chance of celiac disease. Not all of these had celiac symptoms, but five out of the six had symptoms or biopsy results consistent with celiac disease.

In another study, researchers in Hungary found five biopsy-confirmed cases of celiac disease in 111 people with Sjögren's syndrome, many of whom didn't report intestinal symptoms that might have indicated celiac disease.

Based on those results, the Hungarian researchers recommended "screening, follow-up and regular gastrointestinal care" for people with Sjögren's syndrome to help them avoid malnutrition and cancers associated with the untreated celiac disease.

Non-Celiac Gluten Sensitivity, Sjögren's Possibly Linked

It's also possible that Sjögren's syndrome is linked to non-celiac gluten sensitivity. In a study conducted in Sweden and published in the Scandinavian Journal of Gastroenterology, researchers took 20 people with Sjögren's syndrome, plus 18 people without the condition, and had them undergo rectal gluten challenges. In a rectal gluten challenge, a small sample of gluten is placed in the rectum for several hours.

The study found that 15 hours after the gluten was placed in their rectums, five of the Sjögren's patients experienced mucosal changes that indicated gluten sensitivity. Two of those five patients had positive tTG-IgA blood tests, and one had absolutely flat intestinal villi and was therefore diagnosed with celiac disease.

Before the gluten challenge, 15 out of the 20 Sjögren's patients reported gastrointestinal symptoms, and eight said they were intolerant to various foods, including gluten grains. However, the study's authors didn't find a correlation between gluten sensitivity and self-reported food intolerance or gastrointestinal symptoms.

Of course, clinicians still are exploring the concept of non-celiac gluten sensitivity, and it's not clear exactly what type of entity it will turn out to be. Consequently, many physicians still don't accept the diagnosis.

What This Means for People With Sjögren's

For people with Sjögren's syndrome, all this research likely provides food for thought but not much direction. For example, there's no clear evidence that giving up gluten can improve your Sjögren's symptoms, regardless of whether you have celiac disease or not.

However, there is some evidence that people with Sjögren's might want to consider getting tested for celiac disease, especially if they have possible symptoms (remember, not everyone has primarily intestinal symptoms from celiac disease—symptoms can be neurological or skin-based, as well). Of course, you should always complete any celiac testing prior to going gluten-free, since it's impossible to get accurate test results on the gluten-free diet.

Research into all autoimmune conditions, including Sjögren's syndrome and celiac disease, is ongoing, and future studies should provide more answers about the links between the two conditions.

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