{"id":464,"date":"2025-07-11T17:47:28","date_gmt":"2025-07-11T17:47:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/fg\/?p=464"},"modified":"2025-07-11T17:47:28","modified_gmt":"2025-07-11T17:47:28","slug":"glp-1s-tirzepatide-and-masld-a-new-frontier-for-gastroenterologists","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/fg\/2025\/07\/11\/glp-1s-tirzepatide-and-masld-a-new-frontier-for-gastroenterologists\/","title":{"rendered":"GLP-1s, Tirzepatide and MASLD: A New Frontier for Gastroenterologists"},"content":{"rendered":"

As incretin-based therapies and metabolic pharmacology become more embedded in everyday care, gastroenterologists are encountering new challenges\u2014and new opportunities. GLP-1 receptor agonists (GLP-1RAs), tirzepatide, which is a combined GLP-RA and glucose-dependent insulinotropic polypeptide (GIP)\u00a0agonist, and sodium-glucose co-transporter-2 (SGLT2) inhibitors, once viewed as the remit of diabetologists, are now shaping how we approach common GI symptoms, endoscopic safety, and liver disease management.<\/p>\n

Two recent Frontline Gastroenterology<\/em> publications\u2014Lisa Sharkey\u2019s review on anti-obesity medications and the article by Isaacs et al. on metabolic dysfunction\u2013associated steatotic liver disease (MASLD) pharmacotherapy\u2014highlight these developments clearly. But beyond summarising their findings, it is worth reflecting on how they signal a broader shift in our specialty.<\/p>\n

GLP-1RAs in Practice: Familiar Symptoms, New Mechanisms<\/strong><\/p>\n

GLP-1RAs are now widely prescribed for obesity and type 2 diabetes and increasingly in the context of liver disease. As detailed in Sharkey\u2019s review<\/a>, gastrointestinal symptom prevalence is high\u2014nausea (15-59%), vomiting (5-20%), constipation (4-37%), and diarrhoea (5-25%). These effects are physiologically predictable, driven by delayed gastric emptying and altered intestinal motility.<\/p>\n

In practice, however, distinguishing these drug-related effects from primary GI disease can be challenging. I\u2019ve seen several patients referred for investigation of new-onset dyspepsia or constipation, only to find that symptoms followed a recent dose escalation of semaglutide or liraglutide.<\/p>\n

The article\u2019s practical recommendations\u2014focusing on dietary adjustment, trial withdrawal or dose reduction, and selective use of prokinetics\u2014are highly relevant. In particular, Sharkey\u2019s discussion around pre-endoscopy safety stands out. Reports of retained gastric contents despite adequate fasting highlight the need for pre-procedure screening protocols, especially in symptomatic patients.<\/p>\n

This is something I\u2019ve begun to notice in endoscopy units as well: patients attending for gastroscopy or colonoscopy are increasingly on weekly injectable therapies, and our standard \u201cfasting for six hours\u201d guidance may no longer be sufficient. It\u2019s a subtle shift, but one that has clear implications for service safety and workflow.<\/p>\n

MASLD: A New Era of Liver Pharmacotherapy<\/strong><\/p>\n

MASLD (formerly NAFLD) now affects over half of people with type 2 diabetes. For many years, we offered lifestyle advice and monitored fibrosis progression, but pharmacological treatment options were limited. That picture is changing.<\/p>\n

As Isaacs et al. summarise<\/a>, there is now growing evidence to support the use of GLP-1RAs, tirzepatide, and SGLT2 inhibitors in managing hepatic steatosis, inflammation, and even fibrosis:<\/p>\n