Background <p>The risk of non-Hodgkin’s lymphoma in patients with primary Sjögren’s syndrome (pSS) is well established. However, the association between pSS and the risk of gastrointestinal cancers remains underexplored. This study aims to assess the risk of gastrointestinal cancers in pSS patients in Korea compared with the general population.</p> Methods <p>We included 320,082 participants from National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. Of these, there were 850 patients with pSS and 319,232 in the non-pSS group. All participants were followed-up until 2019 or the development of gastrointestinal cancers, whichever occurred first. Hazard ratio (HR) and 95% confidence intervals (95% CI) for gastrointestinal cancers were calculated by multivariable Cox proportional hazards models.</p> Results <p>Compared with the non-pSS group, patients with pSS had a higher risk of developing all gastrointestinal cancers, but the association did not reach statistical significance (adjusted HR: 1.240, 95% CI: 0.990–1.543). Site-specific analyses showed that pSS patients had a higher risk of colorectal cancer (adjusted HR: 1.597, 95% CI: 1.122–2.273) and pancreatic cancer (adjusted HR: 2.294, 95% CI: 1.267–4.151). The association was found to be more prominent in females and elderly (aged ≥ 60) individuals according to subgroup analyses.</p> Conclusions <p>pSS was associated with increased risks of colorectal and pancreatic cancers, particularly among females and older adults. Further research should explore the underlying mechanisms and the impact of pSS duration and severity on cancer risk.</p>