P0648 - A Cautionary Tale in Obesity Management: A Rare Case of Tirzepatide-Associated Functional Gastric Outlet Obstruction

Mina Iskander, MD, MBBCH, Prutha Pathak, MD, Mayal Sandhu, MD
North Alabama Medical Center, Florence, AL

Introduction: Obesity represents a significant medical challenge, many seek adjuvants to dietary and lifestyle adjustments for effective management. After receiving Food and Drug Administration approval for weight loss, tirzepatide, a dual glucose-dependent insulinotropic polypeptide receptor and glucagon-like peptide-1 receptor agonist primarily used in treating Type 2 diabetes mellitus, has gained increased attention for its positive effects on weight loss. Here, we present a rare case of gastric outlet obstruction associated with tirzepatide use.

Case Description/Methods: A 57-year-old male with type 2 diabetes mellitus presented to the Emergency Department with worsening right-sided abdominal pain, for 4 weeks. Nausea, vomiting, and occasional diarrhea developed and progressed over the prior 6 months. Physical examination revealed diffuse abdominal tenderness and distention. Computerized Tomography of the abdomen with contrast demonstrated a distended stomach and fluid-filled bowel loops consistent with gastric outlet obstruction. Naso-gastric tube was used for decompressions and bowel relief.<br><br>Due to the severity of symptoms, it was imperative to conduct esophagogastroduodenoscopy, which revealed no evidence of mechanical obstruction or pathological abnormalities, leading to a diagnosis of functional gastric outlet obstruction. The patient reported that symptoms began after switching from metformin to tirzepatide. Although his symptoms worsened, he was unwilling to stop tirzepatide due to its role in his weight loss.

Discussion: Tirzepatide is known for its safety and benefits, including cardiovascular and weight management. While rare cases of intestinal obstruction have been reported, our case highlights a rare instance of functional gastric outlet obstruction linked to tirzepatide. No other causative factors were found, and tirzepatide was the only recent medication change. The patient's well-controlled diabetes (HbA1c 5.6%) made diabetic gastroparesis unlikely. Despite tirzepatide's weight loss efficacy, patients may be reluctant to stop or reduce their dosage even with significant symptoms. Thus, physicians should consider tirzepatide as a potential cause of serious obstruction and educate patients about its gastrointestinal warning signs and symptoms. ChatGPT was used for grammatical review and rephrasing purposes. No information or data was added by the AI.



Disclosures:


Mina Iskander, MD, MBBCH, Prutha Pathak, MD, Mayal Sandhu, MD. P0648 - A Cautionary Tale in Obesity Management: A Rare Case of Tirzepatide-Associated Functional Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.