In late July 2023, CNN published a shocker of a story, alleging that semaglutide (Ozempic, Wegovy) was causing severe cases of gastroparesis, or delayed stomach emptying, leaving some patients with stomach paralysis that just won’t go away. While Ozempic has change into the world’s buzziest drug since it is so effective for weight reduction, the story seemed especially concerning for individuals with diabetes, because gastroparesis is a typical complication of the condition.

The story raises red flags. Do Ozempic (and related drugs) cause gastroparesis? In the event you have already got gastroparesis, could Ozempic make it even worse?

What’s Gastroparesis?

Gastroparesis is a medical condition defined by delayed stomach emptying. Nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain are amongst its symptoms. It’s a typical complication of diabetes, each types 1 and a couple of, and frequently develops after years or many years after the onset of diabetes. It affects about 3 times more women than men. 

Diabetic gastroparesis is brought on by high blood sugars, likely because hyperglycemia results in vagus nerve dysfunction. That’s the nerve that largely controls the digestive tract. Damage to the vagus nerve means it may possibly’t instruct the stomach and intestinal muscles to work properly, resulting in delayed emptying. In case your stomach isn’t emptying you will feel full — even if you happen to eat little or no — and prolonged delayed emptying causes nausea and vomiting. Because it continues, you possibly can’t obtain adequate nutrition and might’t manage your blood glucose. 

In keeping with the American Gastroenterological Association (AGA), complications of diabetic gastroparesis can include severe dehydration or lack of water and electrolytes from ceaseless vomiting, esophagitis, bezoar (a small mass of food, fiber or other substances within the stomach that forestalls the body from using medications), malnutrition, and reduced quality of life.

Diagnosing Gastroparesis

Pritesh Mutha, M.D. is a gastroenterologist and associate professor at McGovern Medical School at UTHealth Houston. He said it may possibly tackle average as much as five years to diagnose.

“There are multiple reasons,” he explained. “One is a lack of knowledge. Patients present just one symptom and don’t speak about other symptoms because they don’t think they’re necessarily something they need to bring as much as their doctor. Nausea and vomiting are so common it could possibly be brought on by tens of millions of various reasons. That’s why after I give grand rounds I make an appeal to all of the upcoming residents and fellows and college that every time anyone presents with nausea and vomiting, be certain to have a look at the drugs they’re on and ask patients these questions, ‘Are you in a position to get through your entire meal?’ ‘Do you’ve got pain in your belly?’ ‘Do you’re feeling bloated after your meal?’ ‘Do you throw up?’ ‘Does the food you swallow leave a foul-smelling breath?’

“Not all patients have all of the symptoms and won’t even give it some thought until you probe them,” he added. “They’ve modified their dietary habits and lifestyles in such a way that this becomes their latest normal they usually can’t perform their every day activities. It’s only after they reach out to someone who asks them questions that they finally get diagnosed.”

Mutha pointed to the gastric emptying scintigraphy, considered by the AGA because the gold standard for diagnosing gastroparesis. But, he noted, this test may be booked out for months, again adding to the length of time before diagnosis. 

There’s a less complicated method available for screening patients for gastroparesis: “There are only nine questions you’ll want to ask they usually’re the symptom index called the Gastroparesis Cardinal Symptom Index (GCSI). It takes five minutes to fill out.”

The questions ask about nausea, retching, vomiting, stomach fullness, ability to complete a normal-size meal, feeling excessively full after meals, lack of appetite, and bloating. Scores range from none as much as severe — 0 to five. 

Mutha emphasized the great thing about this process is that the patients themselves have seen these questions and the symptoms asked about: “It’s such a straightforward thing I feel may be done to create awareness, make patients their very own advocate, and have doctors within the loop on this process.”

Ozempic, GLP-1 Receptor Agonists, and Gastroparesis

It looks as if Ozempic has been renting space in our heads without cost since its 2017 FDA approval. There are the numerous TV commercials which have given us the Ozempic earworm (Oh oh oh…). Then we began hearing about celebrities like Elon Musk and Chelsea Handler taking this diabetes drug for weight reduction, resulting in host Jimmy Kimmel setting out the 2023 Academy Awards with a joke about it proliferating amongst Hollywood. 

Semaglutide (Ozempic, Wegovy, Rybelsus), dulaglutide (Trulicity), and liraglutide (Victoza) are glucagon-like peptide-1 (GLP-1) receptor agonists used to treat type 2 diabetes. Drugs on this family stimulate the discharge of insulin and suppress glucagon secretion only when blood glucose concentrations are high, stabilizing and lowering blood glucose in individuals with type 2 diabetes. Tirzepatide (Mounjaro) works in the same way.

GLP-1 receptor agonists also stabilize blood sugar by slowing down digestion, retaining food within the stomach for an extended time. Less food equals less sugar within the bloodstream — and lowers food intake by curbing your appetite. It also sends a signal to the brain that you simply’re full. That’s why people on Ozempic and other GLP-1 receptor agonist drugs drop extra pounds.

But because GLP-1 receptor agonists work by slowing down the digestive system, they may also cause delayed gastric emptying — the signature feature of gastroparesis.

When asked if diabetes patients with gastroparesis symptoms should take drugs like Ozempic, Victoza, and Trulicity, Mutha declined to make a definitive statement, explaining that it’s a really difficult situation. Patients with diabetic gastroparesis have to have a conversation with their doctor to weigh the advantages with the chance of uncomfortable side effects.

“We don’t have the information to point out how most of the individuals who take this drug actually experience gastroparesis.” 

The profound stomach paralysis reported by CNN appears to be very rare. In less severe cases, it may possibly be difficult to discover the foundation explanation for gastroparesis. What Mutha advocates is easy — asking some very specific questions. He points back to the GCSI questionnaire:

“That’s where you’ll see the red flags and that may be step one in determining what the situation is,” he explained. “In the event you take a mean of the scores on all nine answers and it’s 2.6 or higher, they’ve something of concern, and you possibly can test to see in the event that they have gastroparesis already. If not, they may be warned that taking the drug may put them in danger for gastroparesis, but possibly not. But you’ve got a very good baseline to start out with.”

Mutha warned that individuals who’ve been diagnosed with gastroparesis that decide to stay on the GLP-1 receptor agonists drugs will keep losing a few pounds, but possibly in an unhealthy way: 

“They change into malnourished and weaker, and lose muscle mass,” he said.

Mutha really useful that patients with any concern make themselves aware of the symptoms of gastroparesis, in order that they’ll readily recognize them if their latest medication appears to be making them worse. After all, if the questionnaire answers show something of concern, Mutha really useful ordering a gastric emptying study.

Treating Gastroparesis

One in all the admittedly frightening issues that got here up within the CNN story was how elusive recovery has been for the people interviewed. Thankfully, such experiences are rare: Most individuals who experience uncomfortable delayed gastric emptying on a GLP-1 receptor agonist like Ozempic appear to recuperate after stopping the drug.

Mutha has treated many patients with gastroparesis and had some direction for people affected by it: 

• Avoid all processed food and animal products, as an alternative eat a weight loss program strictly of fruits, vegetables, nuts, beans, seeds, and whole grains.
• Don’t eat raw vegetables unless they’re blended. Otherwise, cook them well. 
• Chew food thoroughly before you swallow. The smaller the particles, the less workload for the stomach and food may be emptied easily.
• Don’t eat or drink after 6 p.m. That offers your body time to digest. Otherwise, you risk affected by reflux, exacerbated asthma, and even chocking overnight.
• Walk no more but a minimum of quarter-hour after every meal at a straightforward gait. Research has shown that if you happen to walk after a meal, it improves stomach emptying. Not exercising will shut the digestive system down, as will intense exercising.
• Eat every 4 hours. That offers the stomach time to empty out.

More invasive procedures may also help address gastroparesis, including a brand new technique that Mutha favors named G-POEM (gastric per oral endoscopic myotomy). This endoscopy essentially enlarges the opening of a small muscular valve called the pylorus where the stomach meets the small bowel. The pylorus often is closed until nicely digested food hits the stomach to release into the small intestine. When the pylorus doesn’t open, cutting the valve to make the opening wider allows food to enter the small intestine.

GLP-1 receptor agonists may be powerful tools for the management of type 2 diabetes, and by lowering each blood sugar and weight, they’ll make complications like gastroparesis less more likely to occur. Nevertheless, the gastrointestinal symptoms of medication like Ozempic may be very significant, and it is perhaps clever for patients with diabetic gastroparesis to be especially vigilant when taking any latest medication.

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