GLP-1 agonist drugs for weight management could lead to aspiration pneumonia after endoscopy, a recent study found.
- 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.
Weight-loss
drugs slow digestion, facilitate sensation of fullness
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
What
is the overall risk of aspiration?
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
Age might affect
GLP-1 drug risk
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.”
Potential implications for those on weight-loss drugs
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.”
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