The lancet. Gastroenterology & hepatologyAug 3, 2024

How GLP-1 receptor drugs affect digestion: causes, treatment, and future possibilities

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Mar 22, 2026

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may significantly slow gastric emptying.

Marked slowing of gastric emptying is associated with reduced post-prandial blood glucose responses in type 2 diabetes.
Increased gastric retention of food could elevate the risk of aspiration during surgeries or upper gastrointestinal procedures.
Current pre-procedural guidelines are limited due to inadequate evidence regarding the effects of long-acting GLP-1RAs on gastric emptying.
Proposed management pathways for patients on GLP-1RA therapy aim to address these challenges.
Future research priorities include better understanding the gastrointestinal effects of GLP-1RAs.

Simplified

The availability of glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) such as liraglutide and semaglutide, and a GLP-1 and glucose dependent insulinotropic polypeptide coagonist (tirzepatide) represents a paradigm shift in the management of both type 2 diabetes and obesity. There is now considerable attention, including in the public media, on the effect of both long-acting and short-acting GLP-1RAs to delay gastric emptying. Although slowed gastric emptying is integral to reducing post-prandial blood glucose responses in type 2 diabetes, marked slowing of gastric emptying might also increase the propensity for longer intragastric retention of food, with a consequent increased risk of aspiration at the time of surgery or upper gastrointestinal endoscopy. This Personal View summarises current knowledge of the effects of GLP-1 and GLP-1RAs on gastrointestinal physiology, particularly gastric emptying, and discusses the implications for the development of sound pre-operative or pre-procedural guidelines. The development of pre-procedural guidelines is currently compromised by the poor evidence base, particularly in relation to the effect of long-acting GLP-1RAs on gastric emptying. We suggest pre-procedural management pathways for individuals on GLP-1RA-based therapy and discuss priorities for future research.

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Competing interests

Declaration of interests CKR has participated on advisory boards for Glyscend Therapeutics, a company that owns orally administered, gut-targeted polymer therapies and has work underway related to type 2 diabetes and obesity. CKR has received honoraria for lectures from Eli Lilly and Boehringer Ingelheim. KLJ has previously received research funding from Sanofi-Aventis and AstraZeneca; participated on an advisory board for Glyscend Therapeutics (without receipt of payment); and declares stock options, but does not own any stock, in Glyscend Therapeutics. MH declares stocks in Mirum Pharmaceuticals, a company that owns Livmarli (maralixibat), which is approved in the USA and Europe for the treatment of cholestatic pruritus in Alagille syndrome (a genetic liver disorder). Mirum Pharmaceuticals has work underway related to rare liver diseases, but not diabetes or obesity. MH declares stock options, but does not own any stock, in Glyscend Therapeutics; and is a member of the scientific and clinical advisory board for Glyscend Therapeutics. All other authors declare no competing interests.

PubMed

How GLP-1 receptor drugs affect digestion: causes, treatment, and future possibilities

Abstract

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