With the global increase in obesity and diabetes, the use of weight negative therapy, such as the glucagon-like peptide -1 receptor agonists (GLP-1 RA) are increasing. The most common side effects with the GLP-1RA are gastrointestinal symptoms, mainly nausea. Other common adverse effects include headache, injection site reactions, and are usually minor and do not result in cessation of therapy. GLP-1RA are also associated with slowed gastric emptying, by virtue of their mode of action and potentially a gastroparesis (1). Causes of gastric dysmotility include prior gastric surgery (e.g. partial gastrectomy, vagotomy, laparoscopic adjustable gastric banding, and Roux-en-Y gastric bypass). Comorbid medical conditions such as diabetes mellitus are also associated with gastroparesis due to autonomic neuropathy. In diabetics it is therefore worthy to consider pre-existing autonomic dysfunction prior to commencement of GLP-1RA therapy. Gastric bezoars are foreign body masses and are classified according to their composition. Most commonly, patients with gastric bezoars present with nausea and vomiting, epigastric pain, dyspepsia, early satiety, anorexia and weight loss (2). We present a case of a 43 year old non-diabetic woman, with a pre-exisiting gastric band, who commenced on GLP-1RA therapy for weight loss. Gastroscopy some years after band placement but prior to medical therapy endoscopy was normal. Our patient developed the above GI symptoms and was found to have a gastric bezoar 4 months after initiation of GLP1-RA therapy. A radionucleotide study demonstrated severe delay in gastric emptying. removal of the band did not alter the bezoar. Due to the gastric motility slowing effect, patients on GLP-1RAs need to be informed of the risks of impaired gastric emptying. Clinicians need to be particularly aware of at risk populations, namely diabetics and prior bariatric surgical patients. In light of the current GLP-1RA indications, these are the particularly vulnerable populations, and may be more at risk of bezoar formation.
1. Meier JJ. GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2012;8(12):728742.
2. Khan S et al. Upper gastrointestinal manifestation of bezoars and the etiological factors: a literature review. Gastroenterology research and practice. 2019 Jul 15;2019.