3 main links between weight loss injections and gastrointestinal disorders
The rapid adoption of glucagon-like peptide (GLP)-1 receptor drugs to treat obesity and promote weight loss, and their remarkable results in moving the stagnation of this problem forward, has led to a similar interest in the medical community about aspects of her relationship. with the digestive system, that is, its possible side effects and positive benefits.
In the July 17 issue of NEJM Journal Watch Gastroenterology, aspects of this relationship with the digestive system were presented, titled “What Gastrointestinal Side Effects Should Physicians Prescribing GLP-1 Drugs Concern About?” ?”
The importance of this presentation stems from the leadership of its author in gastroenterology, Professor David A. Rinn Johnson, professor of medicine and chief of gastroenterology at the Eastern Virginia Medical School in Norfolk and former president of the American College of Gastroenterology, also assured that his scientific article was of clinically neutral quality, and summarized his reasoning by saying: “Below is a summary of the latest information on ‘ this subject. ” “As well as my best guide to doctors on how to incorporate it into the clinical care of their patients. “
Gastrointestinal pain and infections
In this medical presentation, the abbreviation GLP-1 will be used to refer directly to the “glucagon-like peptide receptor drug class.” Here are the three main associations built in the medical community:
1. Harmful side effects
Researchers from the Mayo Clinic, Florida A&M University, and North Dakota State University conducted their study, published in the February 2 issue of the journal Pharmaceuticals, titled “Gastrointestinal Adverse Events Associated with Glucagon-Like Peptide Receptors -1: Cross-sectional analysis of a group of National Institutes of Health in the United States. They retrospectively studied the results of new use of GLP-1 drugs with more than 10,000 people with diabetes and obesity.
The most common adverse GI events in this group were abdominal pain (57.6%), constipation (30.4%), diarrhea (32.7%), nausea and vomiting (23.4%), and GI bleeding (15.9% ) ), gastroparesis (5.1%) ), and pancreatitis (3.4%).
In detail, it was found that Dulaglutide and Liraglutide had higher rates for abdominal pain, stomach paralysis, constipation, diarrhea, nausea, and vomiting, compared to Semaglutide and Exenatide. However, there were no significant differences between GLP-1 class types in the risk of gastrointestinal bleeding or pancreatitis.
A 2023 report in the journal JAMA noted that the risk of bowel obstruction is also increased among patients who use any type of GLP-1 class drug for weight loss. It is not known exactly why this might be the case at the moment.
Therefore, there is an urgent need today for further studies, to analyze the possible differences in safety profiles between these types of GLP-1 class drugs in order to choose better guide doctors, in a rational way, among the types of these drugs, especially in patients who suffer from risk factors in the digestive system for the possible side effects . This includes patients who have previously undergone surgery in any part of the digestive system, or have active or persistent disease conditions in any part of the digestive system, and those another. In addition, further research and clinical studies are required to establish a causal relationship (cause and effect) between types of GLP-1 and other medications that a person may be taking.
Good effect on fatty liver
2. No liver disturbance
GLP-1 agents have been shown to have significant effects on body weight and glycemic control, as well as beneficial effects on clinical, biochemical and histological markers, in patients with MASLD.
Mayo Clinic doctors say: “Non-alcoholic fatty liver disease has become more common, especially in the Middle East and Western countries, where the number of people with obesity is increasing. It is the most common type of liver disease in the world. The severity of non-alcoholic fatty liver disease ranges from degeneration of hepatic fat, known as fatty liver, to a more severe form of the disease known as non-alcoholic steatohepatitis. When this hepatitis occurs, it causes enlargement and damage of the liver, scarring and cirrhosis, or even leads to liver cancer.
According to Professor David A. Johnson said that these beneficial effects on clinical, biochemical and histological signs in patients with “metabolic fatty liver disease” are manifested by a reduction in the signs of liver degeneration, that is , levels of liver enzymes (aspartate aminotransferase (AST) and alanine aminotransferase. ALT). “GLP-1 species can provide a protective function by reducing the accumulation of triglycerides in the liver and (reducing) the expression of several collagen genes,” he said. “Some clinical data indicate a reduced risk of developing progress to hepatocellular carcinoma”.
In fact, the most recent assessment of the risk reduction of MASLD progression comes from the results of a Scandinavian study published last June in the journal Hepatology, led by researchers from Sweden, Denmark, and United States. When they looked at more than 90,000 patients using this class of drugs, the researchers showed that this treatment was associated with a significant reduction in the incidence of hepatocellular carcinoma, as well as cirrhosis.
With these various positive liver effects, they are likely due to several factors. But even today, it should be noted that the use of any type of GLP-1 drug is not approved by the US Food and Drug Administration for this purpose, that is, to reduce the chances that a fatty liver develops into fibrosis or the appearance of cancer.
Warning about “aspiration pneumonia”
3. Risks of gastroscopy
Doctors take great care in detecting “aspiration pneumonia,” which is inflammation of the lung tissue due to large amounts of stomach contents entering the trachea, and then deep into the lungs. , especially during endoscopy of the upper parts of the digestive system, or under general anesthesia for surgery, or As a result of incomplete vomiting, vomit material is expelled through the mouth and returned by “suction” into the respiratory tract and lungs.
All types of GLP-1 class drugs work to slow the movement of food from the stomach into the intestines. This last effect says, says Professor David A. Johnson, doctors fear that patients who take this class of medication may be exposed during gastric endoscopy – desire co -related to surgery, or anesthesia for surgery, to an increased risk of what is called “aspiration pneumonia.”
As a clinical translation of these concerns, in June 2023, the American Society of Anesthesiologists (ASA) issued recommendations asking providers to consider withholding GLP-1 medications in patients with scheduled elective procedures. The American Gastroenterological Association’s 2024 Rapid Clinical Update was in line with that recommendation.
But there is a medical tendency not to exaggerate this possibility. For example, two recent studies presented at this year’s Digestive Disease Week provided further reassurance that concerns about appetite with these drugs may be unfounded. The first study (since published in The American Journal of Gastroenterology) showed that the level of solid food residue left in the stomach was higher among those who took the GLP-1 class of drugs than among others ( 14 percent against 4 percent,). respectively). However, patients who fasted for a long time and drank clear liquids had lower levels of gastric residuals, and no incidents of procedural complications or aspiration pneumonia were reported. The other study showed that those taking the GLP-1 class of medication had a 36-minute delay in emptying solid food from the stomach, and no delay in emptying liquids from the stomach. stomach The authors concluded that the slight delay in emptying solid food would be compensated by relatively longer fasting periods, prior to the procedure, which might mean that there would be no need to stop a put on these medicines before gastroscopy.
Monitors small levels of cases of gastric paralysis and pancreatitis
How are the side effects of weight loss injections on the digestive system dealt with?
Among a review by Dr. Howard E. Lewin, editor-in-chief of Harvard Health Medical Publishing, titled: “Side effects of weight loss and diabetes drugs related to the GLP-1 Hormone: Ozambik Face and More,” we bring out the following aspects about the relationship between that weight loss. drugs to have a negative effect on the digestive system, and how to deal with it. “Gastrointestinal symptoms—nausea, vomiting, diarrhea, and constipation—are the most common side effects of GLP-1 medications,” he says.
Nausea can be controlled by avoiding strong smells and eating cookies, mints, or foods or drinks containing ginger, about half an hour after taking GLP-1 medications.
Vomiting can be controlled by staying well hydrated by drinking water and eating frequent, smaller meals.
Diarrhea can be controlled by drinking enough water and avoiding dairy products and high-fiber foods until the symptoms disappear.
Constipation can be controlled by getting enough fiber in your diet and drinking enough water.
To help avoid gastrointestinal side effects of GLP-1 medications:
– Eat slowly and stop when you feel full.
– Eat smaller portions.
– Avoid excessive activity immediately after eating.
Less common and more serious side effects of GLP-1 medications include:
– Pancreatitis, which is an inflammation of the pancreatic tissue and causes abdominal pain.
– Gastric paralysis, where the movement of food from the stomach to the bone slows down, or stops completely.
– intestinal barrier, which is a barrier that prevents food from passing through the intestine.
– attacks from gallstones and bile duct obstruction.
You should seek immediate medical attention if:
– severe vomiting and diarrhea.
– Severe abdominal pain, or touching the navel area and around it causes pain.
– Inability to pass gas or stool.
– jaundice (yellow skin color).”
2024-08-22 16:15:10
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