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Diabetes patients on Ozempic-like drugs more likely to develop gastroesophageal reflux disease

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Peer-reviewed: This work was reviewed and scrutinised by relevant independent experts.

Observational study: A study in which the subject is observed to see if there is a relationship between two or more things (eg: the consumption of diet drinks and obesity). Observational studies cannot prove that one thing causes another, only that they are linked.

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Canadian and South Korean researchers say type-2 diabetes patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the group of drugs that includes Ozempic and Wegovy, are more likely to develop gastroesophageal reflux disease (GERD) and its complications than patients on another type of drug, sodium-glucose cotransporter-2 (SGLT-2) inhibitors. GERD is a chronic digestive disorder where stomach acid flows back into the oesophagus, causing heartburn and other symptoms. The study included 24,708 new users of GLP-1 RAs, followed up for an average of three years, and 89,096 new users of SGLT-2 inhibitors, followed up for an average of 2.7 years. The team found the risk of GERD-related complications was higher for smokers, patients with obesity, and patients with other gut illnesses.

Journal/conference: Annals of Internal Medicine

Research: Paper

Organisation/s: Jewish General Hospital, Canada

Funder: This research was funded by a Foundation Scheme grant from the Canadian Institutes of Health Research (FDN-143328). Dr. Noh was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health &Welfare, Republic of Korea (grant number HI22C1234). Dr. Yu is the recipient of a Chercheur-Boursier Clinicien Junior 1 award from the Fonds de Recherche du Quebec – Sante. Dr. Azoulay holds a Distinguished Research Scholar award from the Fonds de Recherche du Quebec – Sante and is the recipient of a William Dawson Scholar Award from McGill University.

Media release

From: American College of Physicians

Risk for GERD is higher with GLP-1 RA use compared to SGLT-2 inhibitor use

A population-based cohort study emulating a target trial estimated the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) compared with sodium-glucose cotransporter-2 (SGLT-2) inhibitors on the risk for gastroesophageal reflux disease (GERD) and its complications in patients with type 2 diabetes. The study found that incidence of GERD and its complications was higher among GLP-1 RA users, risk of GERD-related complications higher for smokers, patients with obesity, and patients with gastric-related comorbidities. The results are published in Annals of Internal Medicine.

Researchers from McGill University and Lady Davis Institute, Jewish General Hospital in Montreal used the U.K. Clinical Practice Research Datalink to create a target trial emulation framework that evaluated the risk for GERD and its complications in patients aged 18 years or older with type 2 diabetes initiating GLP-1 RAs or SGLT-2 inhibitors. The study included 24,708 new users of GLP-1 RAs who had a median follow-up of 3 years and 89,096 new users of SGLT-2 inhibitors who had a median follow-up of 2.7 years. The primary outcome was diagnosis of GERD and secondary outcome was complications of GERD. The researchers found that during follow-up the incidence rate for GERD was 7.9 per 1,000 person years. 138 total complications of GERD were observed, with over 90% of them being Barrett esophagus. At three-year follow-up, the risk ratio (RR) was 1.27 for GERD and 1.55 for GERD complications in GLP-1 RA users compared with SGLT-2 inhibitor users. Secondary analyses found that risks for GERD were higher overall for each GLP-1 RA type except lixisenatide, and risks for GERD complications were higher in ever-smokers, patients with obesity, and patients with gastric comorbidities. The results suggest the risk for GERD and its complications is higher among patients with type 2 diabetes using GLP-1 RAs versus SGLT-2 inhibitors. Clinicians and patients should be aware of the possible adverse effect of GLP-1 RAs on GERD.

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