GLP-1 drugs like Ozempic may raise risk of endoscopy complications

Evan Walker
Evan Walker TheMediTary.Com |
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GLP-1 agonist drugs for weight management could lead to aspiration pneumonia after endoscopy, a recent study found. Image credit: UCG/Getty Images.
  • Researchers at Cedars-Sinai have announced study results suggesting that patients should suspend the intake of certain popular drugs used for weight management in obesity, such as Ozempic and Wegovy, before undergoing endoscopy procedures to mitigate the risk of aspiration pneumonia.
  • This extensive analysis, involving data from nearly 1 million patients in the United States, highlights the dangers posed by these treatments due to their impact on digestion and food retention in the stomach.
  • Given the sheer volume of endoscopies performed annually in the United States, these findings may advocate for a careful reconsideration of medication schedules to reduce the number of aspiration incidents.

The study, published in Gastroenterology, identified that drugs such as Ozempic and Wegovy, which are glucagon-like peptide-1 receptor agonists (GLP-1RAs) used in the management of diabetes and obesity, could lead to a higher chance of developing aspiration pneumonia after undergoing endoscopy procedures.

Aspiration pneumonia arises when foreign substances, such as food from the stomach or secretions from the mouth and nose, are inhaled into the lungs.

Aspiration can lead to infection of the airways and lungs that necessitates treatment, such as antibiotics.

This condition is relatively rare in healthy people but more prevalent among those with pre-existing health issues.

Aspiration pneumonia is a subset of pneumonia, which can be caused by bacterial, viral, or fungal infections within the lungs.

An endoscopy is a procedure where a doctor inserts a tube-like instrument through a patient’s throat to observe the organs inside of the body such as the esophagus, stomach and small intestine.

The recent weight-management drugs achieve their effect by slowing down digestion, extending the sensation of fullness, and thereby reducing food intake. As a result, food remains in the stomach for a longer period.

However, this prolonged presence of food means that the stomach might not be fully emptied during the standard fasting period recommended before surgical interventions to minimize the risk of aspiration.

Ali Rezaie, MD, medical director of the gastrointestinal motility program and the director of bioinformatics at the MAST program at Cedars-Sinai in Los Angeles, CA, explained the key findings to Medical News Today of the study, saying, “[t]he popular weight-loss drugs such as Ozempic are very effective in reducing weight and controlling diabetes.”

“One of the ways these medications work is by decreasing the speed that food travels through the [gastrointestinal] tract especially in the stomach,” he noted. “This is one of the reasons these medications are associated with high rate of nausea and even vomiting.”

“Patients who are on these medications have higher rate of excessive food residual in their stomachs despite going through the usual fasting period prior to procedures or surgeries,” Rezaie explained.

“When patients are sedated for procedures, the food in the stomach can reflux back into the swallowing pipe and throat and some of this food can find its way into the breathing tube and the lungs, a process that is called aspiration,” he added.

“Aspiration can compromise breathing and can have devastating consequences. In some cases aspiration leads to inflammation of the lungs also known as aspiration pneumonia which is usually treated with antibiotics and respiratory support. Patients who are on these medications have 33% higher chance of aspiration ammonia as compared to those who don’t take these medications. This increased risk was seen even after adjusting for underlying comorbidities and other medications that increased the risk of aspiration.”

– Ali Rezaie, MD

Rezaie nevertheless cautioned that it is “important to understand that overall risk of aspiration is still low at 0.8% but if you are on these medications this risk can be reduced to 0.6% (i.e. 33% less) by temporarily holding the medication prior to the procedure if deemed appropriate by your Healthcare provider.”

Jared L. Ross, DO, professor and medical director for the Henry Ford College Paramedic Program and assistant professor of emergency medicine at the University of Missouri, not involved in this research, commented that, “[w]ith any new medication, and especially with a new medication class we are always learning about adverse effects for several years after the drugs come onto the market.”

“We know that glucagon-like peptide-1 (GLP-1) agonists like semaglutide (Ozempic/ Wegovy) delay gastric [stomach] emptying; this is part of how they work to help with weight loss,” Ross noted.

“This is normally not a problem,” he told us. “However, when combined with a procedure that increases the risk of gastric aspiration — inhaling the stomach contents into the lungs — this can be problematic,” he explained.

“Upper endoscopy, which involves putting a camera into the stomach and inflating it with air, is a common procedure that has a risk of gastric aspiration, this appears to be significantly higher in patients using GLP-1 agonists, especially if they are given propofol — a sedating medication that can decrease the protective reflexes of the airway and lungs.”

– Jared L. Ross, DO

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