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

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• 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

The research examined data from almost 1 million anonymized patients in the United Sytates who had undergone upper or lower endoscopy procedures from January 2018 to December 2020.

However, Dr. Ross noted that “surprisingly, this study did not control for patient age.”

This might pose some problems, he said, because “[o]lder patients are more likely to have a weakened esophageal sphincter, which makes it more likely to regurgitate stomach contents.”

“Also, older patients are more likely to develop pneumonia — an infection of the lungs — from aspirating stomach contents,” he further noted.

“In a young, healthy patient, aspiration may cause little or no problems. I feel that we need further information to stratify patient risk by age,” Ross pointed out.

He emphasized that:

“This is an early, retrospective study, we need more research in this area. This study shows the importance of having a discussion with your anesthesiologist if you are taking a GLP-1 agonist, and weighing the risk and benefits of stopping the medication prior to your surgery or procedure.”

Rezaie reiterated that “holding weight loss medications in the category of Ozempic prior to endoscopic procedures that need sedation can decrease the chance of aspiration by 33%.”

“Considering that we perform 20 million endoscopies per year in the U.S., and a significant proportion of the population are on these medications; holding these medications prior to elective procedures can save thousands of lives and hospitalizations,” he told us.

In conclusion, Rezaie said, “[w]eight loss medications such as Ozempic have several health benefits, but we also need to be vigilant about their potential side effects, so we can maximize their positive effects in our society.”