GLP-1RA use prolongs gastric transit time during video capsule endoscopy
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Key takeaways:
- Gastric transit time was significantly longer in the GLP-1RA group vs. the control group (99.3 minutes vs. 25.3 minutes).
- Patients on GLP-1RAs also had lower rates of capsule passage (76.5% vs. 95.6%).
PHILADELPHIA — Glucagon-like peptide-1 receptor agonist use was associated with prolonged gastric transit time and incomplete small bowel evaluation among patients with diabetes undergoing video capsule endoscopy, according to research.
“Video capsule endoscopy is valuable in assessing conditions like GI bleeding, anemia and IBD,” Tarek Odah, MD, a research fellow at the Mayo Clinic in Florida, said at the ACG Annual Scientific Meeting. “GLP-1 receptor agonists have been used for managing diabetes and obesity. Their pharmacological effects include delay of gastric emptying.”
To investigate the effect of GLP-1RA use on video capsule endoscopy (VCE) outcomes among patients with diabetes, Odah and colleagues conducted a retrospective cohort study using electronic medical records from a multicenter academic institution. They identified 68 patients on GLP-1RAs, who were matched with 68 controls not on GLP-1RAs, based on demographics and diabetes-related factors.
Patient characteristics were similar between groups (mean age, 65.2 years; 51.5% women; 85.3% white), with slight variations in HbA1c levels (GLP-1RA = 6.6% vs. controls = 6.8%), blood glucose levels (147.6 mg/dL vs. 137.7 mg/dL) and disease duration (13.8 years vs. 14.6 years).
The primary outcome was VCE gastric transit time, while secondary outcomes were the proportion of patients with incomplete small-bowel evaluation and VCE small-bowel transit time.
According to study results, VCE gastric transit time was significantly longer in the GLP-1RA group vs. the control group (99.3 minutes vs. 25.3 minutes), with GLP-1RA usage increasing transit time by 79.4 minutes (95% CI, 37.8-121), according to multivariate analysis. Although small-bowel transit time was also longer in the GLP-1RA group (262.5 minutes vs. 237.8 minutes), it did not reach statistical significance.
In addition, patients on GLP-1RAs had lower rates of capsule passage through the small bowel vs. controls (76.5% vs. 95.6%).
Sensitivity analysis, which excluded patients with IBD and a history of foregut surgery, demonstrated similar results for gastric transit time (84.5 minutes vs. 24.2 minutes) and VCE passage through the small bowel (78.7% vs. 94.9%).
Types of GLP-1RAs used were fairly equally split between liraglutide (33.8%), dulaglutide (32.4%) and semaglutide (32.4%), with the remaining 1.5% on tirzepatide. Excluding tirzepatide, there were no significant differences in mean gastric or small-bowel transit times between GLP-1RAs.
“Our study of patients undergoing capsule endoscopy while on GLP-1s showed a statistically significant increase in gastric transit time and incomplete small bowel evaluation, along with a nonsignificant increase in small bowel transit time,” Odah said. “Future prospective research is needed to confirm our finding and identify optimal approaches to enhance small bowel evaluation in order to decrease the need for additional diagnostic procedures and associated health care costs.”
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Odah T, et al. Glucagon-like peptide-1 receptor agonists and capsule endoscopic in patients with diabetes: A matched cohort study. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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