AB0469 Evaluation of pilocarpine treatment in xerostomia by pulsed doppler color ultrasonography: echopilo study

Abstract

Objective. Assessment of the evolution of major salivary gland structural involvement is an important issue in the follow-up of patients complaining of xerostomia. The objective of our study was to evaluate the vascularization of parotid glands (PG) using Pulsed Doppler color ultrasonography (USPD) in patients treated by pilocarpine. Methods. We prospectively included patients with objective dry mouth syndrome who attended the Sjögren's Syndrome Multidisciplinary Consultation at Brest University Hospital. The vascularization was assessed by the RI at the left parotid before and after stimulation with lemon. Only patients with pathological RI (<0.8) were included in order to observe RI evolution after pilocarpine. A pulsed doppler USPD of the salivary glands with measure of the vascularization by RI for the parotid glands was carried out by the same operator (SJJ). A dental consultation with measure of salivary flows before and after stimulation was performed. These examinations were performed at baseline and after 3 months of treatment with pilocarpine at 4 mg 3 times daily. Results. Among the 19 patients included, 11 received pilocarpine treatment for the whole 3 months period, 6 of the 8 remaining patients stopped the pilocarpine due to side effects. Among the 11 patients with a follow-up evaluation at 3 months, 5 had primary Sjögren's syndrome according to the American-European's classification criteria. The differences of RI before and after lemon stimulation was on average of -0.04 at baseline and -0.04 at M3. The sum of ultrasound's grades average of the four glands was 3.47 at M0 and 4.18 at M3. The non-simulated salivary flow was on average of 1.96 mL/mn at M0 and 5.23 mL/mn at M3, whereas the average of stimulated salivary flow was 2.84 mL/mn at M0 and 8.51 mL/mn at M3. None of these observed differences were statistically significant: RI before and after lemon stimulation (p=0.953), the sum of the four glands' grades (p=0.858), the non-stimulated (p=0.26) and stimulated salivary flow (p=0.139). Concerning the 3 patients with Sjögren's syndrome, the differences in RI before and after lemon stimulation was lower probably due to a lower initial RI. Conclusion. Preliminary results showed no significant differences between the 4 gland's grade, ultrasound's RI and salivary flow before and after three months of pilocarpine's treatment. The study was marked by a large number of pilocarpine's discontinuation (31 %) due to adverse effects. The vascularisation of salivary glands could be an opportunity to follow our patient with Sjögren's syndrome or with xerostomia but more studies are needed to prove the interest of this procedure.