GLP-1 receptor agonists negatively impact colonoscopy bowel preparation, review finds
Patients taking glucagon-like peptide-1 (GLP-1) receptor agonists were more than twice as likely to experience inadequate bowel preparation for colonoscopy than those not taking the medications, a meta-analysis found.
Using glucagon-like peptide-1 (GLP-1) receptor agonists may increase the risk of inadequate bowel preparation for colonoscopies, a systematic review and meta-analysis found.
The review included five studies that compared bowel preparation quality between GLP-1 receptor agonist users and controls, with a total of 10,833 subjects (5,434 GLP-1 receptor agonist users and 5,399 controls). Three studies were carried out in the United States, one in China, and one in Israel; all took place between 2012 and 2023. The primary outcome was rate of inadequate bowel prep, and the secondary outcome was Boston Bowel Preparation Scale (BBPS) mean score. Findings were published by the American Journal of Gastroenterology on Feb. 12.
The GLP-1 receptor agonist group had a significantly higher rate of inadequate prep than controls (10.6% vs. 4.6%; odds ratio [OR], 2.10 [95% CI, 1.41 to 3.13]; P=0.0003). The average BBPS score was also lower in the GLP-1 group than in the control group (mean difference, −0.34 [95% CI, −0.51 to −0.17]; P=0.0001). The differences in inadequate preparation rates were consistent in a leave-one-out sensitivity analysis and in a subgroup analysis of patients with diabetes (OR, 1.89 [95% CI, 1.20 to 2.98]; P=0.01). Researchers did not find any evidence of publication bias.
Limitations include that the studies were observational and that there was significant heterogeneity in the primary outcome across studies. Included studies also did not account for potential confounders like other medications.
The study authors speculated that the findings are likely attributable to GLP-1 receptor agonists' effects on gastrointestinal motility, “leading to side effects such as nausea and vomiting, which may reduce adherence to bowel preparation protocols.”
The findings underscore the need for increased awareness and more aggressive bowel preparation strategies for patients taking GLP-1 receptor agonists, especially those with additional risk factors for inadequate prep, the researchers wrote.