Gastroesophageal reflux disease and risk for bipolar disorder: A nationwide population-based study

Wan Shan Lin; Li Yu Hu; Chia Jen Liu; Chih Chao Hsu; Cheng Che Shen; Yen Po Wang; Yu Wen Hu; Chia Fen Tsai; Chiu Mei Yeh; Pan Ming Chen; Tung Ping Su; Tzeng Ji Chen; Ti Lu

doi:10.1371/journal.pone.0107694

Gastroesophageal reflux disease and risk for bipolar disorder: A nationwide population-based study

Wan Shan Lin^*, Li Yu Hu, Chia Jen Liu, Chih Chao Hsu, Cheng Che Shen, Yen Po Wang, Yu Wen Hu, Chia Fen Tsai, Chiu Mei Yeh, Pan Ming Chen, Tung Ping Su, Tzeng Ji Chen, Ti Lu

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Studies have shown that chronic inflammation may play a vital role in the pathophysiology of both gastroesophageal reflux disease (GERD) and bipolar disorder. Among patients with GERD, the risk of bipolar disorder has not been well characterized.

Objective: We explored the relationship between GERD and the subsequent development of bipolar disorder, and examined the risk factors for bipolar disorder in patients with GERD.

Methods: We identified patients who were diagnosed with GERD in the Taiwan National Health Insurance Research Database. A comparison cohort without GERD was matched according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts based on diagnosis and the prescription of medications.

Results: The GERD cohort consisted of 21,674 patients, and the comparison cohort consisted of 21,674 matched control patients without GERD. The incidence of bipolar disorder (incidence rate ratio [IRR] 2.29, 95% confidence interval [CI] 1.58-3.36, P<.001) was higher among GERD patients than among comparison cohort. Multivariate, matched regression models showed that the female sex (hazard ratio [HR] 1.78, 95% CI 1.76-2.74, P =.008), being younger than 60 years old (HR 2.35, 95% CI 1.33-4.16, P=.003), and alcohol use disorder (HR 4.89, 95% CI 3.06-7.84, P=.004) were independent risk factors for the development of bipolar disorder among GERD patients.

Conclusions: GERD may increase the risk of developing bipolar disorder. Based on our data, we suggest that attention should be focused on female patients younger than 60 years, and patients with alcohol use disorder, following a GERD diagnosis.

Original language	English
Article number	e107694
Journal	PLoS ONE
Volume	9
Issue number	9
DOIs	https://doi.org/10.1371/journal.pone.0107694
State	Published - 25 Sep 2014

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10.1371/journal.pone.0107694

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@article{176e68386485407cbdfc589cca8d06fc,

title = "Gastroesophageal reflux disease and risk for bipolar disorder: A nationwide population-based study",

abstract = "Background: Studies have shown that chronic inflammation may play a vital role in the pathophysiology of both gastroesophageal reflux disease (GERD) and bipolar disorder. Among patients with GERD, the risk of bipolar disorder has not been well characterized.Objective: We explored the relationship between GERD and the subsequent development of bipolar disorder, and examined the risk factors for bipolar disorder in patients with GERD.Methods: We identified patients who were diagnosed with GERD in the Taiwan National Health Insurance Research Database. A comparison cohort without GERD was matched according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts based on diagnosis and the prescription of medications.Results: The GERD cohort consisted of 21,674 patients, and the comparison cohort consisted of 21,674 matched control patients without GERD. The incidence of bipolar disorder (incidence rate ratio [IRR] 2.29, 95% confidence interval [CI] 1.58-3.36, P<.001) was higher among GERD patients than among comparison cohort. Multivariate, matched regression models showed that the female sex (hazard ratio [HR] 1.78, 95% CI 1.76-2.74, P =.008), being younger than 60 years old (HR 2.35, 95% CI 1.33-4.16, P=.003), and alcohol use disorder (HR 4.89, 95% CI 3.06-7.84, P=.004) were independent risk factors for the development of bipolar disorder among GERD patients.Conclusions: GERD may increase the risk of developing bipolar disorder. Based on our data, we suggest that attention should be focused on female patients younger than 60 years, and patients with alcohol use disorder, following a GERD diagnosis.",

author = "Lin, {Wan Shan} and Hu, {Li Yu} and Liu, {Chia Jen} and Hsu, {Chih Chao} and Shen, {Cheng Che} and Wang, {Yen Po} and Hu, {Yu Wen} and Tsai, {Chia Fen} and Yeh, {Chiu Mei} and Chen, {Pan Ming} and Su, {Tung Ping} and Chen, {Tzeng Ji} and Ti Lu",

note = "Publisher Copyright: {\textcopyright} 2014 Lin et al.",

year = "2014",

month = sep,

day = "25",

doi = "10.1371/journal.pone.0107694",

language = "English",

volume = "9",

journal = "PLoS ONE",

issn = "1932-6203",

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TY - JOUR

T1 - Gastroesophageal reflux disease and risk for bipolar disorder

T2 - A nationwide population-based study

AU - Lin, Wan Shan

AU - Hu, Li Yu

AU - Liu, Chia Jen

AU - Hsu, Chih Chao

AU - Shen, Cheng Che

AU - Wang, Yen Po

AU - Hu, Yu Wen

AU - Tsai, Chia Fen

AU - Yeh, Chiu Mei

AU - Chen, Pan Ming

AU - Su, Tung Ping

AU - Chen, Tzeng Ji

AU - Lu, Ti

PY - 2014/9/25

Y1 - 2014/9/25

N2 - Background: Studies have shown that chronic inflammation may play a vital role in the pathophysiology of both gastroesophageal reflux disease (GERD) and bipolar disorder. Among patients with GERD, the risk of bipolar disorder has not been well characterized.Objective: We explored the relationship between GERD and the subsequent development of bipolar disorder, and examined the risk factors for bipolar disorder in patients with GERD.Methods: We identified patients who were diagnosed with GERD in the Taiwan National Health Insurance Research Database. A comparison cohort without GERD was matched according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts based on diagnosis and the prescription of medications.Results: The GERD cohort consisted of 21,674 patients, and the comparison cohort consisted of 21,674 matched control patients without GERD. The incidence of bipolar disorder (incidence rate ratio [IRR] 2.29, 95% confidence interval [CI] 1.58-3.36, P<.001) was higher among GERD patients than among comparison cohort. Multivariate, matched regression models showed that the female sex (hazard ratio [HR] 1.78, 95% CI 1.76-2.74, P =.008), being younger than 60 years old (HR 2.35, 95% CI 1.33-4.16, P=.003), and alcohol use disorder (HR 4.89, 95% CI 3.06-7.84, P=.004) were independent risk factors for the development of bipolar disorder among GERD patients.Conclusions: GERD may increase the risk of developing bipolar disorder. Based on our data, we suggest that attention should be focused on female patients younger than 60 years, and patients with alcohol use disorder, following a GERD diagnosis.

AB - Background: Studies have shown that chronic inflammation may play a vital role in the pathophysiology of both gastroesophageal reflux disease (GERD) and bipolar disorder. Among patients with GERD, the risk of bipolar disorder has not been well characterized.Objective: We explored the relationship between GERD and the subsequent development of bipolar disorder, and examined the risk factors for bipolar disorder in patients with GERD.Methods: We identified patients who were diagnosed with GERD in the Taiwan National Health Insurance Research Database. A comparison cohort without GERD was matched according to age, sex, and comorbidities. The occurrence of bipolar disorder was evaluated in both cohorts based on diagnosis and the prescription of medications.Results: The GERD cohort consisted of 21,674 patients, and the comparison cohort consisted of 21,674 matched control patients without GERD. The incidence of bipolar disorder (incidence rate ratio [IRR] 2.29, 95% confidence interval [CI] 1.58-3.36, P<.001) was higher among GERD patients than among comparison cohort. Multivariate, matched regression models showed that the female sex (hazard ratio [HR] 1.78, 95% CI 1.76-2.74, P =.008), being younger than 60 years old (HR 2.35, 95% CI 1.33-4.16, P=.003), and alcohol use disorder (HR 4.89, 95% CI 3.06-7.84, P=.004) were independent risk factors for the development of bipolar disorder among GERD patients.Conclusions: GERD may increase the risk of developing bipolar disorder. Based on our data, we suggest that attention should be focused on female patients younger than 60 years, and patients with alcohol use disorder, following a GERD diagnosis.

UR - http://www.scopus.com/inward/record.url?scp=84907466362&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0107694

DO - 10.1371/journal.pone.0107694

M3 - Article

C2 - 25255080

AN - SCOPUS:84907466362

SN - 1932-6203

VL - 9

JO - PLoS ONE

JF - PLoS ONE

IS - 9

M1 - e107694

ER -

Gastroesophageal reflux disease and risk for bipolar disorder: A nationwide population-based study

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