Ozempic and Delayed Gastric Emptying

May 07, 2024By Murat Ustun
Murat Ustun

Ozempic and Delayed Gastric Emptying 

Semaglutide, sold under brand names like Ozempic® and Wegovy®, is a weightloss medication that has been linked to cases of gastroparesis (delayed gastric emptying). Semaglutide belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists that regulate appetite and caloric intake. These drugs are known to potentially cause delayed gastric emptying. 

Explaining Gastroparesis

Gastroparesis is a medical condition affecting the stomach’s muscle movement, disrupting the regular flow of food through the digestive system. Typically, the stomach muscles facilitate this movement.

The condition alters stomach motility, either slowing it down significantly or causing it to stop altogether. This impairment hinders the emptying of stomach contents, leading to discomfort such as stomach pain, nausea, and vomiting. Currently, there’s no definitive cure or standard treatment for gastroparesis.

The Mechanism Behind Ozempic-Induced Gastroparesis

Both Ozempic and its counterpart, Wegovy, designed for weight management, share the active ingredient semaglutide. These medications, classified as GLP-1 agonists, mimic the hormone glucagon-like peptide-1 (GLP-1) naturally produced in the body.

Impact on Stomach Movement

GLP-1, responsible for slowing down food passage in the gastrointestinal tract, induces a feeling of fullness. Ozempic and Wegovy replicate this hormone, creating a sensation of satiety.

Development of Stomach Paralysis

Prolonged slowing of food passage leads to gastroparesis or stomach paralysis. This delay impedes food movement from the stomach to the intestines, potentially causing blockages and bowel obstructions.

Ozempic Wegovy injection

Evaluating Gastroparesis Risk with Ozempic

While Ozempic contributes to gastroparesis, it’s not the sole cause. Diabetes, often the reason for Ozempic prescription, can also lead to gastroparesis. In some cases, the cause remains unidentified.

Complications and Symptoms

Gastroparesis entails various distressing symptoms such as nausea, bloating, abdominal pain, early satiety, vomiting undigested food, blood sugar fluctuations, acid reflux, reduced appetite, malnutrition, and weight loss.

Other Ozempic Side Effects

Aside from gastroparesis, Ozempic usage can trigger hypoglycemia, various stomach issues, gallbladder complications, pancreas diseases, allergic reactions, and ileus. The American Society of Anesthesiologists advises caution before surgery due to potential complications.

In a 2-year study on semaglutide for overweight/obesity, 82.2% of patients experienced mild to moderate gastrointestinal (GI) side effects like nausea and vomiting, compared to 53.9% on placebo. However, no cases of gastroparesis were reported in this study. While GLP-1 agonists can initially cause GI issues, these effects typically reduce after 20 weeks of use. In some cases, discontinuing the medication may resolve gastroparesis.

The most common underlying cause of gastroparesis is diabetes, which can damage the vagus nerve controlling stomach/intestine muscular function. Other potential causes include celiac disease, neurological disorders, autoimmune diseases, hypothyroidism, and certain medications like opioids and antidepressants.

There are limited case studies of GLP-1 agonists like semaglutide potentially inducing gastroparesis in some patients. A few women have reported developing severe GI issues after semaglutide treatment, with some being diagnosed with gastroparesis. One woman has sued the manufacturers alleging lack of warning on this risk.

While the medication labels mention delayed gastric emptying as a side effect, they do not specifically list gastroparesis as a potential risk. As semaglutide's use increases, more gastroparesis reports are expected. The FDA has received some reports but cannot confirm if the medication directly caused gastroparesis.

For suspected gastroparesis, clinicians recommend discontinuing semaglutide, dietary modifications, anti-nausea medications, and prokinetic agents to improve gastric emptying. More research is needed on managing medication-induced gastroparesis and whether semaglutide can be safely reinitiated after symptom resolution.​​​​​​​​​​​​​​​​