surgical interventions can be considered. These include proximal or distal (digital) sympathectomy and arterial reconstruction. Distal sympathectomy is associated with a lower complication rate than proximal sympathectomy, but long-term outcomes have not been documented thoroughly. Angiography should be performed if macrovascular or larger-vessel occlusive disease amenable to revascularization appears to be an issue.

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Chapter 16

Gastrointestinal Involvement in Primary

Sjögren’s Syndrome

Manuel Ramos-Casals, José Rosas, Roser Solans, Margit Zeher, and Peter Szodoray

M. Ramos-Casals (*)

Spanish Group of Autoimmune Diseases (GEAS), Spanish Society of Internal Medicine (SEMI), Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, ICMD Hospital Clínic, Barcelona, Spain

J. Rosas

Department of Rheumatology, Hospital de la Vila-Joiosa, Alicante, Spain

R. Solans

Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain

M. Zeher • P. Szodoray

Medical and Health Science Center, Clinical Immunology Division, University of Debrecen, Debrecen, Hungary