Diabetes and weight problems GLP-1 medicine like Ozempic, which might delay abdomen emptying, have launched a predicament for sufferers present process surgical procedures and endoscopies — the sufferers in some instances should have meals of their abdomen even when they’ve fasted, elevating issues that they may by chance breathe meals into their lungs through the procedures.
These issues have been based mostly on anecdotes, and it’s to this point unclear how large a difficulty that is, however a brand new research published in Gastroenterology Wednesday provides some early clues. It hyperlinks GLP-1 medicine to the next threat of aspiration pneumonia — lung an infection brought on by meals breathed into the lungs — following endoscopies.
Researchers, analyzing a big dataset of well being data, discovered that individuals taking GLP-1 medicine total had a really low 0.83% threat of this an infection, however that they had a 33% larger threat in contrast with individuals who weren’t on GLP-1 therapies.
Zooming in on the various kinds of endoscopies, the researchers discovered that amongst individuals present process higher endoscopies, GLP-1 drug customers had an 48% greater threat of aspiration pneumonia, and for mixed higher endoscopies and colonoscopies, that they had greater than double the chance. The researchers didn’t discover a greater threat amongst individuals getting solely colonoscopies.
For sufferers who used the sedative propofol for his or her endoscopies, GLP-1 customers had a 49% greater threat of aspiration pneumonia, in accordance with the evaluation, which included data of almost 800,000 sufferers.
The research checked out information from 2018 to 2020, when Ozempic had already been available on the market, however earlier than the newest GLP-1 therapies like Wegovy, Mounjaro, and Zepbound had been accepted. It’s unclear how precisely these newer and stronger therapies would possibly have an effect on sufferers’ threat for aspiration, however they do make the most of the identical or related drug mechanisms as Ozempic, and the research factors to the necessity for extra analysis to assist information medical doctors as extra individuals begin taking these extremely well-liked medicines.
“They’re right here to remain and their use goes to extend. They simply have this complication,” mentioned Ali Rezaie, senior writer of the research and medical director of the GI Motility Program at Cedars-Sinai. “That is all about consciousness. This isn’t about, ‘OK, let’s not use GLP-1s’ or something. It’s nearly, ‘let’s watch out while you’re doing procedures on these sufferers.’”
Previous to this research, two physician teams issued differing statements about what to do with GLP-1 medicine earlier than procedures. The American Society of Anesthesiologists recommended that sufferers ought to cease taking the therapies forward of procedures. In the meantime, the American Gastroenterological Affiliation said that there’s inadequate proof for a proper guideline and recommended medical doctors ought to consider every affected person individually.
Barbara Jung, president of the AGA, mentioned that given the restrictions of the research, she doesn’t suppose it could change what the affiliation mentioned in its assertion, and “we want extra info earlier than we’d.”
This research is proscribed because it’s observational and doesn’t show that GLP-1 drug use causes an elevated threat of aspiration. Regardless of the research’s reliance on well being data, the researchers couldn’t affirm how persistently sufferers had been taking GLP-1 medicine earlier than the procedures. Additionally, they included instances of aspiration pneumonia that occurred inside a month of the procedures, however had no method of confirming whether or not the an infection essentially stemmed from the procedures.
Rezaie, the senior writer, mentioned that though absolutely the threat of aspiration pneumonia for individuals taking GLP-1 medicine was beneath 1%, there are more than 20 million endoscopies carried out within the U.S. every year, so a small share might quantity to many instances. And whereas aspiration pneumonia can typically be handled with antibiotics, they will trigger issues in some instances for people who find themselves immunocompromised or have pre-existing lung issues, he added.
It’s doubtless there’s a greater threat in procedures that contain higher endoscopies particularly, for the reason that affected person is intermittently mendacity down and their stomachs get expanded with carbon dioxide, which might enhance the probabilities of aspiration, the authors wrote. There’s most likely additionally the next threat with using propofol, for the reason that sedative blocks the physique’s reflexes for safeguarding the airway, the authors mentioned.
They be aware that not all instances of aspiration throughout endoscopies lead to aspiration pneumonia, and so there have been doubtless many extra instances of aspiration that weren’t captured within the research.
Given the research design, the research must be thought of “as primarily hypothesis-generating,” mentioned Andrew Wang, chief of the division of gastroenterology and hepatology at College of Virginia who was not concerned within the research. Wang co-authored the AGA statement about using GLP-1 medicine.
He famous that the research additionally doesn’t present info on whether or not stopping the medicine forward of procedures would mitigate the chance of aspiration.
General, although, he mentioned, “this research is essential as we want extra information in regards to the attainable penalties for sufferers utilizing [GLP-1 drugs] previous to GI endoscopy.”
STAT’s protection of persistent well being points is supported by a grant from Bloomberg Philanthropies. Our monetary supporters usually are not concerned in any selections about our journalism.
