What to Know About Stomach Paralysis and GLP-1s

Stomach paralysis can result from a variety of factors, but is a documented side effect of taking GLP-1 drugs like Ozempic and Wegovy.

If food is taking too long to leave the stomach, due to a condition called gastroparesis, it can harden into masses called bezoars, according to the National Institutes of Health. These can lead to blockages in the intestine and other issues.

Stomach paralysis, alongside more common symptoms like vomiting and nausea, is something that Dr. Shilpa Mehra Dang, a gastroenterologist at Medical Offices of Manhattan, said needs to be kept in mind by both patients and clinicians.

“The link between GLP-1 drugs and stomach paralysis isn’t fully known yet,” Dang told Healthline. “But it’s thought that it has to do with how these drugs affect the autonomic nervous system, which is in control of the digestive tract’s bodily functions. It is very important for doctors and nurses to keep an eye on patients who are taking GLP-1 receptor agonist drugs for any signs of stomach problems, such as sickness, vomiting, bloating, and feeling full before they should. These are all symptoms of gastroparesis.”

Weight loss specialists like Dr. Mir B. Ali, a bariatric surgeon, want to make it clear that severe stomach paralysis is still a rare side effect.

“I was somewhat surprised to see this as a long-term complication with patients continuing to experience problems even after stopping the medication,” Ali said. “I would caution patients who already have a diagnosis of gastroparesis not to use this medication and make all patients aware of this. However, I would also inform them that the incidence of this side effect is relatively low.”

Since Wegovy was approved for weight loss by the FDA, having already been found to treat Type 2 diabetes effectively, research into reported side effects has been ongoing.

In data given to the FDA, Novo Nordisk reported that in a trial with over 3,000 participants, six people out of 2,116 given Wegovy developed stomach paralysis. Comparatively, in the group of 1,261 who received a placebo, four people developed the condition as well.

The latest reports of stomach paralysis came after the FDA received complaints via their public reporting system, according to CNN.

Dr. Andrew Boxer, gastroenterologist at Gastroenterology Associates of New Jersey, is among a number of gastroenterologists who says he’s seeing an increased number of patients coming into his practice complaining of side effects from these types of drugs.

“I was seeing a tremendous amount of people coming in just with nausea, vomiting, and feelings of fullness, early satiety, just not feeling well … Universally these patients were on GLP-1’s.”

Boxer says there are two main issues when it comes to treating patients with these symptoms. First, they may be unaware that these side effects were even a possibility. Second, he says that many people don’t think to mention that they are taking these medications at all, especially if they’ve started them since their last visit.

“They’re seeing a GI doctor for a colonoscopy. They think you [only] need to know about constipation, diarrhea, blood in the stool if someone had colon cancer in their family, and that’s it,” Boxer said.

Dr. Amy Lee, Chief Medical Officer at the California-based Lindora clinic, prescribes GLP-1s as part of her practice. She says that she hasn’t seen any patients who have experienced severe side effects. However, she emphasized that communication about all possible side effects including severe ones is vital to patient health.

“I think some of my patients have this mentality of, ‘Just give me this medication, I don’t want to hear more about it. I just want to take it like right now, as soon as possible.’ But you really, truly, do need to sit down with a provider who’s managing your medications, who’s following up with you to document all side effects,” Lee said.

Lee, whose work involves obesity medicine, also says that clinicians need to be mindful when it comes to possible candidates for these medications who have a previous history of gastrointestinal issues. She wants people to know that it’s important for practitioners to be able to differentiate between what might be a drug side effect versus a symptom.

“Understanding your patient population is key. And also, if someone comes in with a lot of gastric issues in the first place, then don’t put them on something that you know is going to actually slow down their gut even more. Because you’re not doing anyone a favor, you may be causing more harm than good.”

If you’re having side effects from these drugs, a physician can order tests to identify whether the medication is the problem. Boxer says that one of the first steps, after discussing your symptoms, would be to get a gastric emptying study.

“That’s when you give a patient a radio-labeled food, usually an egg sandwich or sometimes oatmeal, and use serial X-rays or different images to look to see how quickly things are [going] through the stomach.”

From there, patients may be told to stop their GLP-1 and given medications to counteract these symptoms.

Regardless of possible pathways to treatment, Dang said that symptoms like fluctuating blood sugars, heartburn, bloating, or vomiting should all be reason enough for a patient taking a GLP-1 drug to check in with a medical professional.

“If a patient has any of these signs or is worried about possible side effects, they should talk to their healthcare provider as soon as possible. Early diagnosis and treatment are important for dealing with gastroparesis well and avoiding problems.”