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• Regurgitation of food
• Reflux of gastric acid into the esophagus (neutralizing properties of saliva are lacking)
• Nausea
• Epigastric pain
• Gastritis - irritation of the stomach lining that causes "heartburn"
• Celiac spru - food sensitivity to gluten
• Presence of Helicobacter pylori which is associated with MALT lymphoma
• Gastrotracheal reflux - gastric acid refluxes not just to the esophagus but up to the trachea. Continual reflux can lead to abnormal changes in tracheal tissue.

Laboratory studies may show elevated levels of certain gastric enzymes (e.g., gastrin) and biopsy may show infiltration of lymphocytes into the gastric mucosa. Development of pancreatitis is rare in patients with Sjogren's syndrome.

Neurologic Symptoms

Approximately 10%-30% of Sjogren's patients (some estimates are as high as 60%) develop neurological symptoms including:

• Sensory neuropathy- neuropathy involving sensory nerves (nerves involved in feeling) resulting in pain.
• Peripheral neuropathy - affects the peripheral nerves of the hands and feet and can cause numbness, tingling, pain, and muscle weakness.
• Cranial neuropathy - most often affects the trigeminal nerve and may cause a condition called trigeminal neuralgia (intense, sharp pain in the area of the face).
• Transverse myelitis - an acute spinal cord disorder causing sudden low back pain, muscle weakness, and abnormal sensations in the lower extremities. This is one of several sclerosis-like syndromes that may occur in up to 1% of patients with Sjogren's syndrome.
• Abnormal nerve conduction
• Motor neuropathy
• Demyelinating neuropathy
• Myelopathy (conditions affecting the spinal cord)
• Loss of small-diameter nerve fibers

It is sometimes difficult to differentiate between age-related and Sjogren's syndrome-related neurological symptoms since there is considerable overlap between them. Also, the most common age of onset of Sjogren's syndrome is at a time in life when common aging changes may occur naturally. Thus information is limited regarding specific neurologic symptoms in elderly patients with Sjogren's syndrome.

Gynecologic Symptoms

The most common gynecological manifestation of Sjogren's syndrome in women is vaginal dryness which leads to significant general discomfort. It has been estimated that up to 25% of women with Sjogren's syndrome complain of vaginal symptoms but fertility and childbirth do not appear to be affected by the presence of Sjogren's syndrome. Dyspareunia, painful intercourse, is thought to affect approximately 40% of premenopausal women and is secondary to insufficient lubrication of the vaginal region.

When vaginal dryness develops, it should be treated promptly because it can cause:

• Uncomfortable vaginal itching
• Difficulty in urination
• Urinary tract infections
• Yeast infections

It is thought that vaginal lubrication involves fluid from the bloodstream and from the cervical mucosa that flows through the vaginal wall, and is not related to fluid produced by local glands. When women develop Sjogren's syndrome, lymphocytic inflammatory cells infiltrate the vascular system supplying fluid to the vagina thereby causing a reduction in vaginal lubrication.

Hematologic Abnormalities

Hematologic abnormalities in Sjogren's syndrome are usually asymptomatic and include:

• Elevated sedimentation rate - this is reported in up to 70% of patients with Sjogren's syndrome.
• Anemia - the number of red blood cells in the bloodstream is lower than normal