Anti-obesity drugs for the gastroenterologists

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used in the management of diabetes mellitus and obesity and have become accessible to many through non-standard prescribing pathways. Studies are demonstrating a plethora of positive effects on cardiovascular health, renal disease and liver disease, which may be directly related to the mitigation of the diabetes or obesity-associated risks of these complications or possibly direct protective effects. However, these agents slow gastrointestinal motility, which can lead to side effects of increased gastro-oesophageal reflux, nausea, vomiting, constipation or paradoxical diarrhoea. More severe adverse effects include cholelithiasis, acute pancreatitis and increased risk of medullary cell thyroid cancer. Gastroenterologists are being increasingly consulted for the side effects, and a discussion around best management of these symptoms is presented. Safety around endoscopic procedures has also been subject to much discussion, and the latest guidance is outlined for endoscopists.