GLP-1 Receptor Agonists and Bowel Prep: Impact on Colonoscopy Quality

THURSDAY, June 13, 2024 — The administration of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) for treating diabetes or obesity appears to be linked to reduced bowel preparation quality in patients undergoing colonoscopy, according to research published online in the June edition of the American Journal of Gastroenterology.

The study, led by Dr. Rebecca Yao from the Mayo Clinic in Rochester, Minnesota, involved a retrospective cohort examination of patients who underwent screening or surveillance colonoscopy at a major academic medical center. The objective was to determine if the use of GLP-1 RAs compromises the quality of bowel preparation. For the purposes of the study, patients who were currently on GLP-1 RAs for diabetes or obesity during their colonoscopy were designated as the case group. Meanwhile, those who had been prescribed GLP-1 RAs previously but had discontinued their use at least three months prior to the colonoscopy served as the control group. The study included 265 individuals in the case group and 181 in the control group.

Upon adjusting for the variable of diabetes, the researchers observed a notable difference in the mean Boston Bowel Preparation Score (BBPS) between the two groups. The control group had a significantly higher average BBPS of 7.5 ± 2.4 compared to the case group's score of 7.0 ± 1.9. Furthermore, a greater percentage of individuals in the case group exhibited a total BBPS score of less than 5 (15.5% versus 6.6%). Additionally, the case group had a higher incidence of patients requiring a repeat colonoscopy because of inadequate bowel preparation, with 18.9% needing a follow-up procedure compared to 11.1% in the control group.

The findings suggest that the use of GLP-1 RAs may adversely impact the effectiveness of bowel preparation before a colonoscopy. The authors underscore the importance of understanding how medications that potentially slow gastric emptying can affect bowel preparation. They highlight the necessity of developing appropriate strategies and providing thorough counseling to patients who are scheduled for outpatient colonoscopy procedures while on GLP-1 RAs.

The implications of this study are significant for healthcare providers and patients alike. Enhanced awareness and proactive management strategies could help mitigate the observed negative effects on bowel preparation among users of GLP-1 RAs, thereby improving the overall effectiveness and diagnostic quality of colonoscopies. Future research may focus on further elucidating the mechanisms by which GLP-1 RAs affect bowel preparation and on identifying specific measures that can help maintain high standards of bowel cleanliness for optimal colonoscopy outcomes.

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