Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA, Australia.
Department of Medicine, Haukeland University Hospital, Bergen, Norway.
Lancet Gastroenterol Hepatol. 2024 Oct;9(10):957-964. doi: 10.1016/S2468-1253(24)00188-2. Epub 2024 Aug 1.
The availability of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) such as liraglutide and semaglutide, and a GLP-1 and glucose dependent insulinotropic polypeptide coagonist (tirzepatide) represents a paradigm shift in the management of both type 2 diabetes and obesity. There is now considerable attention, including in the public media, on the effect of both long-acting and short-acting GLP-1RAs to delay gastric emptying. Although slowed gastric emptying is integral to reducing post-prandial blood glucose responses in type 2 diabetes, marked slowing of gastric emptying might also increase the propensity for longer intragastric retention of food, with a consequent increased risk of aspiration at the time of surgery or upper gastrointestinal endoscopy. This Personal View summarises current knowledge of the effects of GLP-1 and GLP-1RAs on gastrointestinal physiology, particularly gastric emptying, and discusses the implications for the development of sound pre-operative or pre-procedural guidelines. The development of pre-procedural guidelines is currently compromised by the poor evidence base, particularly in relation to the effect of long-acting GLP-1RAs on gastric emptying. We suggest pre-procedural management pathways for individuals on GLP-1RA-based therapy and discuss priorities for future research.
胰高血糖素样肽-1（GLP-1）受体激动剂（RAs）如利拉鲁肽和司美格鲁肽，以及 GLP-1 和葡萄糖依赖性胰岛素促分泌多肽共激动剂（替西帕肽）的出现，代表了 2 型糖尿病和肥胖症治疗模式的转变。现在人们对长效和短效 GLP-1RA 延迟胃排空的作用给予了相当多的关注，包括在大众媒体上。尽管减缓胃排空对于降低 2 型糖尿病餐后血糖反应至关重要，但胃排空明显减缓也可能增加食物在胃内滞留时间延长的倾向，从而在手术或上消化道内窥镜检查时增加吸入的风险。本个人观点总结了 GLP-1 和 GLP-1RA 对胃肠道生理学，特别是胃排空的影响，并讨论了这对制定合理的术前或术前指南的影响。由于证据基础薄弱，特别是关于长效 GLP-1RA 对胃排空的影响，目前术前指南的制定受到了影响。我们为接受 GLP-1RA 治疗的个体提出了术前管理途径，并讨论了未来研究的优先事项。
