GLP-1 Receptor Agonists and GERD Risk

Mechanism of GERD Worsening

GLP-1 receptor agonists delay gastric emptying by inhibiting gastric peristalsis while increasing pyloric tone through vagal nerve-mediated pathways, leading to increased gastric volumes and reduced phasic gastric contractions, which can worsen GERD symptoms 1, 2
The delay in gastric emptying is more pronounced in patients with normal or rapid baseline emptying, meaning those without pre-existing gastroparesis face greater risk 2, 3

The American Heart Association recommends avoiding GLP-1 receptor agonists in patients with pre-existing gastroparesis or delayed gastric emptying as they will exacerbate symptoms 4
Patients with pre-existing GERD or erosive esophagitis should avoid GLP-1 receptor agonists 2, 4
If GLP-1 therapy is necessary despite GERD, prioritize long-acting formulations and start at lowest doses and titrate slowly 2, 4
Reducing meal size and avoiding high-fat diets may help mitigate GERD risk 2