Most patients needn't stop GLP-1 drugs before surgery

Hello Health Rounds readers! Today we feature three studies from this week's American College of Gastroenterology meeting in Philadelphia, including one with important implications for those taking popular GLP-1 drugs to lose weight or for diabetes.

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In a practice-changing guideline reversal, medical societies advised on Tuesday that most patients do not need to stop taking GLP-1 diabetes and weight-loss drugs before surgery, a ruling supported by a study presented this week at a medical meeting of gastrointestinal doctors.

The study also suggests that patients undergoing endoscopy might benefit from following a clear liquid diet for a day in advance, although that was not included in the new guidelines.

Patients typically fast before undergoing anesthesia in order to empty the stomach. An empty stomach allows for better examination via endoscopy and lowers the risk of aspiration, a life-threatening complication involving inhalation of gastric contents.

Because GLP-1 drugs such as Novo Nordisk's Ozempic and Wegovy and Zepbound and Mounjaro from Eli Lilly slow stomach emptying, surgeons had been requiring patients to stop those drugs well in advance of anesthesia in order to ensure an empty stomach.

But a new review of 35 studies involving more than 714,000 patients undergoing upper-gastrointestinal endoscopy found no extra risk of aspiration in patients who had not paused their use of GLP-1 drugs beforehand.

They were compared with patients who either were not using the drugs or were using them but had stopped them well in advance of surgery.

The findings were presented by Dr. Violeta Popov of NYU Langone Health NY VA Harbor Health System on Wednesday at the American College of Gastroenterology meeting in Philadelphia.

Procedures more often had to be stopped early in patients who had not stopped the GLP-1 drugs, possibly because significant amounts of food remained in the stomach, her team found. However, retained gastric contents were not a problem in a subset of patients taking GLP-1 drugs who had been on a liquid diet for 24 hours because they were also undergoing colonoscopy on the same day.

Therefore, the researchers suggest, it might be best to follow a 24-hour clear liquid diet prior to GI endoscopy without discontinuing GLP1 therapy.

A pre-malignant condition of the esophagus is becoming more common at younger ages, researchers have found, suggesting  potential benefits from earlier screening.

Barrett's esophagus is usually diagnosed around age 60, but a new study of more than 2.6 million patients found a significantly increasing trend of young-onset Barrett's esophagus from 2014 to 2023, researchers reported at the  gastroenterology meeting.

In Barrett's esophagus, stomach acid has damaged the lining of the lower esophagus, increasing the risk for cancer.

Treatment may include medicines and surgery. Patients with mild cases are advised to undergo endoscopy on a regular basis to monitor the cells in the esophagus lining.

In the new study, 20% of participants had been diagnosed before age 50, with early-stage disease in nearly all cases.

Risk factors in younger patients were similar to those in older patients, including hiatal hernia, gastrointestinal reflux, smoking, and high body mass index, Dr. Anila Vasireddy of the University of Pennsylvania Health System reported.

"Our study validates that conventional risk-factors of Barrett's esophagus in older patients also predict young-onset Barrett's esophagus," her team said in a written summary.

"Screening... before the age of 50 may have a significant impact on early detection of esophageal adenocarcinoma," they said.

Medications for treating alcohol use disorder are underused in U.S. patients and particularly in patients with alcoholic liver disease, researchers reported at the Philadelphia gastroenterology meeting.

Pharmacotherapy is an important tool for treating addiction and preventing progression of liver disease. But among 26,985 commercially insured patients with alcohol use disorder who did not have liver disease, only 14.5% had been prescribed medication. That rate dropped to 2.3% among 1,201 alcohol abuse patients with liver disease, the researchers said.

Patients with the most severe alcoholic liver disease had the lowest odds of receiving drug therapy for their alcoholism, Dr. Alex Jones of the University of Texas Southwestern Medical Center reported.

Gabapentin was the most commonly prescribed medication in the study, followed by oral naltrexone and topiramate.

"Providers caring for patients with alcoholic liver disease should consider this underutilized therapy, or refer for psychiatric consultation when appropriate," the researchers said.

This newsletter was edited by Bill Berkrot; additional reporting by Shawana Alleyne-Morris.

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