ASGE Annual GI Advanced Practice Provider Course (Virtual) (Day One) | March 2026-GLP-1 Therapies GI Implications and Patient Management

Pdf Summary

GLP-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 therapy (e.g., tirzepatide) are incretin-based medications used for type 2 diabetes and chronic weight management, available in injectable daily/weekly and oral forms. Because these agents delay gastric emptying, increase satiety via central nervous system pathways, and alter gut motility and nutrient sensing, gastrointestinal (GI) adverse effects are common—reported in up to 40–70% of patients—especially during initiation and dose escalation. This contributes to high real-world discontinuation rates.<br /><br />Common GI symptoms include nausea, vomiting, diarrhea (which may reflect overflow from constipation), constipation, early satiety/bloating, and heartburn/dyspepsia. Less common but more serious concerns include gastroparesis (rare/controversial association), bowel obstruction/ileus, gallbladder disease, and acute pancreatitis.<br /><br />Key risk factors for intolerance are rapid titration, higher starting doses, pre-existing GI disease, concomitant drugs affecting motility, and use of compounded products. Recommended patient selection and baseline assessment emphasize reviewing GI history and hydration/eating patterns and screening for “red flags” such as known gastroparesis, chronic nausea/vomiting, prior pancreatitis, severe refractory constipation, or uncontrolled GERD/Barrett’s esophagus.<br /><br />Prevention focuses on “start low and go slow,” extending titration schedules when needed, and counseling on lifestyle changes (small frequent meals; avoid high-fat, fried/greasy foods; respond to fullness cues). Management strategies include reassuring patients that nausea/vomiting often improve within 2–4 weeks, prioritizing protein, avoiding very high-roughage meals during symptoms, pausing dose escalation or temporarily reducing dose, using short-term antiemetics if necessary, and treating constipation. For diarrhea/constipation, a 1-view KUB can help distinguish true diarrhea from overflow and assess for ileus/obstruction; use oral electrolyte replacement and dietary adjustments for diarrhea, and fiber plus osmotic laxatives (e.g., polyethylene glycol) for constipation.<br /><br />Therapy should be held or stopped for persistent nausea/vomiting, severe abdominal pain, or intolerable symptoms despite dose adjustments. Adherence improves with proactive counseling, individualized titration, routine follow-up after initiation, and consistent lifestyle reinforcement.

Asset Subtitle

Sarah Kosinski, DNP, APRN, FNP-BC

Keywords

GLP-1 receptor agonists

dual GIP/GLP-1 therapy

tirzepatide

gastrointestinal adverse effects

delayed gastric emptying

nausea and vomiting management

dose titration start low go slow

constipation and overflow diarrhea

gastroparesis and ileus risk

patient counseling and adherence