P0516 - Glucagon-Like Peptide Receptor Agonist (GLP-1 RA) Use is Not an Independent Predictor of Gastroesophageal Reflux Disease (GERD) on Quantitative Reflux Testing

Robinderpal Sandhu, DO¹, Alexandria Markley, MD², Emily Seltzer, DO, MS², Rama Hussein, DO³, Joseph Abraham, MD, MBA⁴, Binoy Desai, DO², James Choi, MBBS¹, Yuying Luo, MD⁵, Kimberly Cavaliere, MD⁶, Michael S.. Smith, MD, MBA⁷, Daniela Jodorkovsky, MD^5
1Mount Sinai Morningside, Icahn School of Medicine at Mount Sinai, New York, NY; ²Mount Sinai West, Icahn School of Medicine at Mount Sinai, New York, NY; ³Mount Sinai Morningside, New York, NY; ⁴Mount Sinai Health System, New York, NY; ⁵Mount Sinai Center for Gastrointestinal Physiology & Motility, New York, NY; ⁶Icahn School of Medicine at Mount Sinai Morningside/West, New York, NY; ⁷Icahn School of Medicine at Mount Sinai, New York, NY

Introduction: There is recent increased Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) utilization for diabetic and weight management. These medications are thought to increase satiation through delayed gastric emptying, which is considered a risk factor for Gastroesophageal Reflux Disease (GERD). This study aims to determine whether GLP-1 RA use can predict GERD as defined by quantitative testing and/or findings on upper endoscopy (EGD).

Methods: Patients presenting to a single high-volume motility center for ambulatory reflux testing and EGD between 1/2020 and 2/2024 were identified. Patients taking a GLP-1 RA were included in the analysis, while patients with prior foregut endoscopic or surgical interventions were excluded. Demographics, comorbidities, medications, and testing metrics were obtained. GERD was defined by the presence of Los Angeles Grade B, C, or D esophagitis or Barrett’s metaplasia and/or abnormal pH testing with cutoff values derived from the Lyon Consensus 2.0. Differences between patients on and off GLP-1 RAs were evaluated using logistic regression, t-tests, or Fisher’s exact tests as appropriate.

Results: A total of 457 patients met inclusion criteria, of which 59 were on a GLP-1 RA. Patients on GLP-1 RAs were older, had an increased body mass index (BMI), hemoglobin A1c, and were more likely to have diabetes (Table_1). Mean overall acid exposure time and post-prandial exposure time were significantly higher in GLP-1 RA users (8.5 vs. 5.4, 10.9 vs 4.0, respectively). When adjusting for age, BMI, race, gender, and the presence of a hiatal hernia > 3 cm, GLP-1 RA patients did not have either more GERD (OR 1.73, CI: .84 - 3.55, p =.137), an abnormal pH Study (OR 1.86, CI: .88 - 3.93, p =.105), or more esophagitis (OR 1.84, CI: .68 - 4.95, p=.23) (Table_2).

Discussion: GLP-1 RA use was not an independent predictor for an abnormal quantitative reflux study after adjusting for variables associated with GERD, such as high BMI and hiatal hernia. However, given that GLP-1 RA users had higher post-prandial reflux exposure times, lifestyle and dietary modification may play a role in managing GLP-1 RA users’ reflux symptoms. Further studies investigating outcomes of results when GLP-1 RAs are held prior to testing, or whether duration of use alters GERD detection rates should be performed, as reflux testing often informs clinical decision making.


Disclosures:


Robinderpal Sandhu, DO¹, Alexandria Markley, MD², Emily Seltzer, DO, MS², Rama Hussein, DO³, Joseph Abraham, MD, MBA⁴, Binoy Desai, DO², James Choi, MBBS¹, Yuying Luo, MD⁵, Kimberly Cavaliere, MD⁶, Michael S.. Smith, MD, MBA⁷, Daniela Jodorkovsky, MD⁵. P0516 - Glucagon-Like Peptide Receptor Agonist (GLP-1 RA) Use is Not an Independent Predictor of Gastroesophageal Reflux Disease (GERD) on Quantitative Reflux Testing, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.