We read with interest the recent study by Liu et al, which investigated associations between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and increased gastro-oesophageal reflux disease (GERD) in patients with type 2 diabetes.1 This large retrospective analysis of real-world data raises important clinical considerations, but also has limitations that warrant thoughtful interpretation.

The extensive dataset of more than 127 million patients enables the detection of subtle signals, and propensity-score matching probably adapts well for measured confounders. Therefore, the main findings, increased risks of incident GERD and complications related to GERD with short-acting but not long-acting GLP-1 RAs, deserve attention. However, several factors should be considered before applying these …