Increased risk of concurrent gastroesophageal reflux disease among patients with Sjögren's syndrome: A nationwide population-based study

  • Author Footnotes
    1 Chen-Shu Chang and Chun-Hui Liao contributed equally.
    Chen-Shu Chang
    1 Chen-Shu Chang and Chun-Hui Liao contributed equally.
    Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan

    Department of Medical Laboratory Science and Biotechnology, and Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan
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  • Author Footnotes
    1 Chen-Shu Chang and Chun-Hui Liao contributed equally.
    Chun-Hui Liao
    1 Chen-Shu Chang and Chun-Hui Liao contributed equally.
    Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan

    Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
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  • Chih-Hsin Muo
    Management Office for Health Data, China Medical University, Taichung, Taiwan

    School of Medicine, China Medical University, Taichung, Taiwan
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  • Chia-Huang Kao
    Corresponding author at: No. 2, Yuh-Der Road, Taichung 404, Taiwan. Tel: +886 4 22052121x7412; fax: +886 4 22336174.
    Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan
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  • Author Footnotes
    1 Chen-Shu Chang and Chun-Hui Liao contributed equally.
Published:February 04, 2016DOI:


      • The risk of GERD among SS patients was 2.41-fold greater than that for the general population.
      • The youngest SS patients had the highest risk and the lowest risk at age ≥65 years.
      • SS patients without comorbidity had a 2.87-fold risk higher than comparison cohort.



      Little data is available on the risk of gastroesophageal reflux disease in patients diagnosed with Sjögren's syndrome.


      We identified 4650 Sjögren's syndrome patients between 2000 and 2011 from the National Health Insurance Research Database. Each Sjögren's syndrome patient was matched to 4 controls based on age, sex, and index year, and all subjects were followed up from the index date to December 31, 2011. Cox proportional hazards regression model was used to estimate the risk of gastroesophageal reflux disease.


      The risk of gastroesophageal reflux disease for Sjögren's syndrome patients was 2.41-fold greater than that for the comparison cohort after adjusting for age, sex, and comorbidities. In age stratified analyses, the youngest Sjögren's syndrome cohort (age: 20–44 years old) had the highest risk (HR = 3.02; 95% CI = 2.48–3.69) and the lowest risk at age ≥65 years (HR = 1.95; 95% CI = 1.61–2.36). Regardless of in subjects with and without comorbidity, Sjögren's syndrome patients had a higher risk than the controls. Sjögren's syndrome subjects with ischemic heart disease, hyperlipidemia and renal disease had the highest risk for gastroesophageal reflux disease compared with the comparison cohort without those diseases (HR = 7.67; 95% CI = 5.32–11.1).


      Patients with Sjögren's syndrome have a significantly greater risk of developing subsequent gastroesophageal reflux disease than the general population.


      ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), HR (hazard ratio), CI (confidence interval), NHIRD (National Health Insurance Research Database), LHID-CIP (longitudinal health insurance database for catastrophic illness patients), NHI (National Health Insurance), LHID (the longitudinal health insurance database), TBNHI (Taiwan Bureau of National Health Insurance), IRB (Institutional Review Board)


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