Salivation disorders at ankylosing spondylitis as a factor of oesophageal alteration

Abstract

Objective — to investigate the peculiarities of oesophageal lesions in patients with ankylosing spondylitis (AS) depending of the salivation state.Materials and methods. Examinations involved 50 patients with AS, in all cases specific esophageal complaints arose at least once a week. All patients underwent sialometry and esophagoscopy. The obtained results were compared with the results of the control group consisting of 20 healthy persons aged 40 to 50 years. Statistical processing of the results included the determination of Student’s t­test, the Yul’s association coefficient and the criterion φ*.Results and discussion. Patients were divided into two groups, according to the results of endoscopic examination. The main group consisted of 26 patients with erosive esophagitis, the comparison group included 24 patients with AS without erosive lesions of the esophageal mucosa. It has been established that more than half the patients in the main group was disturbed by xerostomia, compared to the quarter of the patients in the comparison group. Moreover, the direct associative correlation has been established between the sensation of dry mouth and erosive esophagitis. The existence of an association between erosive lesion of the esophagus and the presence of glossitis and/or stomatitis has also been established. There was a decrease in stimulated saliva secretions in both groups of patients compared with healthy individuals and in intergroup comparison. Basal salivation was reduced in patients in the main group compared to patients in the comparison group and controls. Along with this, this index in the comparison group was not different when compared with the same index of persons in the control group. Obtained data indicated a relative decompensation of the salivary secretory mechanisms in the comparison group, which are still able to provide basal secretion, but are rapidly depleted upon their stimulation. The basis for alterative changes in the oesophageal zone is formed under conditions of suppression of both types of salivation. It has been established that the basal and stimulated salivation indices in patients with the 3rd clinical an radiologic stage of AS were less compared to those in patients with 2nd stage of AS. Salivation dysfunction can be considered an extra­articular manifestation of AS, which plays a leading role in the formation of oesophageal lesions. The duration of the disease and its prolonged inflammatory activity affects the expressiveness of hyposalivation.Conclusions. Salivation dysfunction is inherent in patients with AS. It is manifested by xerostomia, oppression of basal and stimulated salivation. Oro-oesophageal zone of the digestive tract is the target organ for alteration in hyposalivation dysfunction in patients with AS. Erosive esophagitis in patients with AS is formed under conditions of a decrease in both basal and stimulated salivation. The interrelated and simultaneous lesions of the esophagus and oral cavity organs in patients with AS is a consequence of hyposalivation and violations of cytoprotection mechanisms that have arisen as a result of a prolonged autoimmune process.