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Bidirectional association between fibromyalgia and gastroesophageal reflux disease: two population-based retrospective cohort analysis

Wang, Jia-Chia; Sung, Fung-Changb; Men, Maurandac; Wang, Kevin A.d,e; Lin, Cheng-Lif,g; Kao, Chia-Hungh,i,j,*

doi: 10.1097/j.pain.0000000000000994
Research Paper

Fibromyalgia (FM) tends to coexist with gastroesophageal reflux disease (GERD). This retrospective cohort study was conducted to determine the bidirectional association between FM and GERD, using a nationwide database, the National Health Insurance of Taiwan. We established 2 study arms, including 35,117 patients with FM in arm 1 and 34,630 patients with GERD in arm 2, newly diagnosed between 2000 and 2010. For each study arm, we randomly selected 4-fold subjects with neither FM nor GERD from the same database, frequency matched by sex, age, and diagnosis date, as the respective control cohorts. Incidence of GERD in arm 1 and incidence of FM in arm 2 were estimated by the end of 2011. The overall incidence of GERD was 1.6-fold greater in the FM cohort than in the non-FM cohort (12.0 and 7.61 per 1000 person-years, crude hazard ratio [HR] = 1.58, 95% confidence interval [CI] = 1.51-1.66), with an adjusted HR (aHR) of 1.27 (95% CI = 1.22-1.33) after controlling for sex, age, comorbidities, and medications. The GERD cohort ultimately had a 1.5-fold higher incidence of FM than the non-GERD cohort (5.76 vs 3.96 per 1000 person-years), with an aHR of 1.44 (95% CI = 1.29-1.60). The present study suggests a bidirectional relationship between FM and GERD. There is a greater risk of developing GERD for patients with FM than developing FM for patients with GERD.

The present study suggests a bidirectional relationship between fibromyalgia (FM) and gastroesophageal reflux disease (GERD). There is a greater risk of developing GERD for patients with FM than developing FM for patients with GERD

aDepartment of Physical Medicine and Rehabilitation, National Yang-Ming University and Taipei Veterans General Hospital, Taipei, Taiwan

bDepartment of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan

cHarvard University, Intended A.B. Physics, Cambridge, MA, USA

dDivision of General Surgery, Department of Surgery, Shin-Kong Memorial Hospital, Taipei, Taiwan

eDepartment of Surgery, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

fManagement Office for Health Data, China Medical University Hospital, Taichung, Taiwan

gCollege of Medicine, China Medical University, Taichung, Taiwan

hGraduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan

iDepartment of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

jDepartment of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan

Corresponding author. Address: Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Rd, Taichung 404, Taiwan. Tel.: 886-4-22052121, ext. 7412; fax: 886-4-22336174. E-mail address: d10040@mail.cmuh.org.tw (C.-H. Kao).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received December 05, 2016

Received in revised form April 13, 2017

Accepted June 21, 2017

© 2017 International Association for the Study of Pain
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