Dry eyes and unexplained gut problems led to a late diagnosis — the test doctors say should be requested sooner
A farmer’s years of pain and normal scans highlight a little-known autoimmune condition that mainly affects women and is often missed without targeted testing
Louise Mountford spent more than a year seeking answers for severe gut symptoms and persistent dry eyes before clinicians identified a little-known condition that commonly affects women. Her experience — including an emergency ambulance trip for agonising abdominal pain and repeated normal endoscopies — underscores doctors’ warnings that patients with unexplained dry eyes and systemic symptoms should be assessed for Sjögren’s syndrome using specific tests.
Mountford, 66, who runs a farm in Shropshire, said she was taken to hospital by ambulance after an episode of intense pain under her right ribs. Despite high doses of pain relief, she remained in extreme discomfort. Hospital scans found no clear cause and clinicians initially treated her for probable constipation, administering an enema and intravenous paracetamol. The episode came amid a longer history of gut disturbances — alternating constipation and explosive diarrhoea, painful bloating and difficulty swallowing dry food — alongside persistent dry eyes.
Mountford underwent both gastroscopy and colonoscopy, tests that examine the upper and lower gastrointestinal tract, which returned no abnormal findings. Because those investigations did not explain her symptoms, clinicians later considered an autoimmune cause. Specialists advised testing for Sjögren’s syndrome, an autoimmune disorder that primarily attacks the glands that produce tears and saliva and can affect other organs, including the gastrointestinal tract.
Clinicians commonly use a Schirmer’s test to measure tear production and blood tests to detect autoantibodies linked with Sjögren’s, including anti-Ro (SSA) and anti-La (SSB). A salivary gland biopsy can provide definitive confirmation in some cases. Physicians and patient advocates say asking for these investigations earlier in the diagnostic pathway can reduce delays in diagnosis and limit unnecessary procedures and repeat imaging.
Sjögren’s syndrome most often affects women, frequently appearing in middle age, and can present with a wide spectrum of symptoms beyond dry eyes and mouth. Patients may report fatigue, joint pain and a range of gastrointestinal complaints related to altered gut motility and secretion. Because many standard gastrointestinal tests focus on structural problems, autoimmune causes can be missed unless they are specifically sought.
Experts note that diagnostic delays are common because symptoms mimic more prevalent conditions and because general practitioners may not immediately associate eye symptoms with digestive complaints. When routine endoscopies and imaging do not identify a cause, clinicians say a careful review of symptoms and targeted testing for autoimmune markers is warranted.
For patients, the practical takeaway recommended by specialists and patient support groups is to describe the full range of symptoms to a primary care clinician and to ask whether testing for Sjögren’s syndrome is appropriate when dry eyes or dry mouth occur with systemic or unexplained gastrointestinal problems. Referral to a rheumatologist is often advised when blood tests or clinical signs suggest an autoimmune process.
Treatment for Sjögren’s focuses on symptom relief and managing systemic manifestations. Artificial tears and saliva substitutes address gland dysfunction, while systemic immunomodulatory medications may be considered for extraglandular involvement. Management of gastrointestinal symptoms typically involves supportive care and, where appropriate, therapies aimed at improving gut motility or addressing specific complications.
Mountford’s case illustrates the challenges faced by people whose symptoms cross specialty boundaries. After years of normal scans and inconsistent explanations, targeted testing led to a diagnosis that linked her dry eyes and gut problems. Clinicians and patient groups say heightened awareness among both patients and primary care clinicians could shorten the time to diagnosis for others with similar presentations.
Those concerned about persistent dry eyes combined with unexplained systemic symptoms are advised to seek medical advice and to discuss Schirmer’s testing, serologic testing for Sjögren’s-related autoantibodies and possible rheumatology referral with their doctor. Early recognition can change the focus of care from repeated structural investigations to multidisciplinary management of an autoimmune condition that predominantly affects women.