Sjogren's and SIBO
Abdominal or gastro issues, anyone?
I’ve recently been feeling really bloated, lethargic, and just can’t quite think very clearly. At first, I thought it was just the usual autoimmune flare, but the Prednisone didn’t seem to help. Then I remembered that I had felt similarly last year, when I was diagnosed with SIBO.
For those of you who don’t know, SIBO is small intestinal bacterial overgrowth and can sometimes result from taking probiotics and acid reducers (from my personal experience). My gastroenterologist told me that SIBO is actually very common among his Sjogren’s patients. So, I thought I’d write a post on how Sjogren’s is linked to gastrointestinal diseases like SIBO. SIBO symptoms can include abdominal pain, nausea, bloating, loss of appetite, diarrhea, weight loss and/or brain fogginess.
A study from the website of the National Institute of Health indicates that gastrointestinal disease “may occur in one quarter of the patients” with Sjogren’s and include symptoms of “dysphagia, gastritis, motility disorders . . . and irritable bowel syndrome (IBS).” I also found a 2019 study from the American College of Rheumatology that specifically looked at the correlation between primary Sjogren’s and SIBO.
“Gastrointestinal disease in SS may occur in one quarter of the patients and include dysphagia, gastritis, motility disorders, pancreatitis, pancreatic insufficiency, pernicious anemia, autoimmune hepatitis and symptoms consistent with irritable bowel syndrome (IBS), abdominal pain, diarrhea, constipation, bloating, flatulence, vomiting and nausea.”
In the SIBO study,* 60 patients with primary Sjogren’s were studied. They were first divided into 2 groups: the first with high disease activity scores for Sjogren’s (the “Active Group”) and the second with relatively low scores (the “Stable Group”). The study found that 93.33% of Sjogren’s patients in the Active Group was positive for SIBO, and 56.67% of Sjogren’s patients in the Stable Group tested positive for SIBO. This difference was statistically significant, with error rates of less than 5%. What this means is that Sjogren’s patients with high levels of disease activity or active symptoms were very likely (93%) to also have SIBO!
"Sjogren’s patients with high levels of disease activity or active symptoms were very likely (93%) to also have SIBO!"
Although I couldn’t find any definitive answers on the prevalence of SIBO among the general population, the National Institute of Health suggests that it is likely somewhere from 0 to 20% of the general population. That’s a huge difference compared to 57% of patients with relatively inactive Sjogren’s symptoms testing positive for SIBO, and 93% of patients with active Sjogren’s symptoms having SIBO!
I think it’s crazy that comorbidities like SIBO have such high correlations to Sjogren’s, but were never mentioned to me by my rheumatologists. It was only from a gastroenterologist that I learned about how susceptible I was to having SIBO.
I’m very vexed about how fragmented our healthcare system is (in the US)--how while gastrologists know Sjogren’s patients have many digestive issues, rheumatologists do not! You would think the different doctors speak to each other and learn about how their different fields are interrelated, especially with regard to systemic diseases like Sjogren’s (cause let’s face it, it’s absolutely NOT just try eyes and dry mouth).
Like and share if you thought this post was helpful. Also, please share if you have any gastrointestinal issues and how you’ve dealt with them. I’d love to hear your stories and I’ll share more about my ordeal with gastritis and stomach ulcers (from taking too much NSAIDs).
For the full studies and resources, the links are listed below:
*Of course, this is only one study with a relatively small sample size. But the results are significant enough to warrant further investigation into the connection between Sjogren's and SIBO.