Introduction

Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP-1 RAs) have gained attention for their role in managing type 2 diabetes and obesity. These drugs help regulate blood sugar levels and promote satiety. This effect benefits weight management, as it supports better control over eating habits and can lead to significant weight loss in some patients. In addition, recent studies showed promising influences on reducing alcohol consumption.

Aims & Methods

This systematic review assesses the impact of GLP-1 RA treatment on alcohol consumption behaviors. Following PRISMA guidelines, this study is conducted through a comprehensive search in PubMed, EMBASE, Scopus, Cochrane, and ClinicalTrials.gov up to February 1, 2025. It included participants with occasional or excessive alcohol use, focusing on self-reported intake, alcohol-related diagnoses, relapse rates, and neuroimaging. Data extraction and risk-of-bias assessments were independently performed by reviewers using the CASP tool, with both qualitative and quantitative synthesis of outcomes.

Results

Thirteen studies are included in this study with a sample size of 5,246,188 participants. The GLP-1 RAs consisted of Semaglutide, Exenatide, Liraglutide, Dulaglutide, and Tirzepatide. The overall mean alcohol intake decreased significantly from 11.8 ± 1.0 to 4.3 ± 0.5 units per week (p < 0.001) ¹. At week 12, participants in the dulaglutide group consumed approximately 29% less alcohol than those in the placebo group (adjusted relative effect = 0.71, 95% CI 0.52–0.97, P = 0.04) ². In contrast, a randomized controlled trial (RCT) involving Exenatide showed no difference in alcohol consumption (in grams) between the treatment and placebo ³. Additionally, two observational studies reported significant reductions in Alcohol Use Disorders Identification Test (AUDIT) scores with Semaglutide (B = -5.1, SE = 1.3, p < 0.001) and Tirzepatide (B = -6.7, SE = 1.3, p < 0.001) ^4,5. An additional observational study demonstrated a notable decrease in AUDIT-Consumption compared to unexposed individuals (DiD: 0.09 points, 95% CI: 0.03–0.14, p = 0.0025) ⁶. The CASP assessments rated most studies as moderate to high quality.

Conclusion

GLP-1 receptor agonists appear to offer a promising, effective, and well-tolerated pharmacological approach for reducing alcohol consumption and preventing relapse in alcohol use disorder (AUD). Further large-scale randomized trials are required to confirm their efficacy and guide clinical practice.

References

1. O’Farrell M, Almohaileb FI, le Roux CW. Glucagon-like peptide-1 analogues reduce alcohol intake. Diabetes Obes Metab. 2025;27(3):1601-1604. doi:10.1111/DOM.16152
2. Probst L, Monnerat S, Vogt DR, et al. Effects of dulaglutide on alcohol consumption during smoking cessation. JCI Insight. 2023;8(22). doi:10.1172/JCI.INSIGHT.170419
3. Klausen MK, Jensen ME, Møller M, et al. Exenatide once weekly for alcohol use disorder investigated in a randomized, placebo-controlled clinical trial. JCI Insight. 2022;7(19). doi:10.1172/JCI.INSIGHT.159863
4. Quddos F, Hubshman Z, Tegge A, et al. Semaglutide and Tirzepatide reduce alcohol consumption in individuals with obesity. Scientific Reports 2023 13:1. 2023;13(1):1-12. doi:10.1038/s41598-023-48267-2
5. Richards J, Dorand MF, Royal K, Mnajjed L, Paszkowiak M, Simmons WK. Significant Decrease in Alcohol Use Disorder Symptoms Secondary to Semaglutide Therapy for Weight Loss: A Case Series. J Clin Psychiatry. 2023;85(1). doi:10.4088/JCP.23M15068
6. Farokhnia M, Tazare J, Pince CL, et al. Glucagon-like peptide-1 receptor agonists but not dipeptidyl peptidase-4 inhibitors reduce alcohol intake.

Disclosure

The authors declare no conflicts of interest regarding the publication of this abstract. All findings and conclusions are the authors' own and do not represent the views of any funding organizations or institutions.

Introduction

Non-alcoholic fatty liver disease (NAFLD) is a significant public health concern. Social media (SoMe) is increasingly popular in lower-middle-income countries and can potentially influence perceptions and understanding of illness. Approximately one-third of Sri Lanka's population uses SoMe for health information. We assessed the quality of NAFLD-related content on SoMe.

Aims & Methods

This observational, cross-sectional study aimed to assess the accuracy, completeness and quality of SoMe content relating to NAFLD across Facebook, YouTube, TikTok, Instagram and X (Twitter) from Sri Lanka, in Sinhala, English, and Tamil languages. Posts containing keywords related to NAFLD published between January 2005 to December 2024 were evaluated. Specialist gastroenterologists independently reviewed the content using standardized scales for accuracy (0-3), completeness (0-5), and global quality score (GQS) (0-5). Posts were categorized by source profile [healthcare institution (HI), healthcare professional (HP), alternative healthcare professionals (AHP), non-healthcare person (NHP), or undisclosed identity (UI)] and content type [health education (HEd), health promotion (HProm), HEd and HProm or product endorsement]. User interactions (likes, shares, views) were also analyzed and correlated with reviewer scores.

Results

The analysis included 289 SoMe posts [158 (54.7%) YouTube, 101 (34.9%) Facebook, 14 (4.8%) TikTok, 11 (3.8%) X, 5 (1.7%) Instagram] relating to NAFLD in three languages [214 (74.0%) Sinhala, 54 (18.7%) Tamil, 21 (7.3%) English]. Posts from UI (36.0%) and NHP (26.0%) comprised the majority of content sources. HP (22.1%), AHP (14.2%), and HI (1.7%) represented the remainder. HProm (61.9%) was the predominant content type followed by HEd and HProm (17.6%), HEd alone (11.8%), and product endorsement (8.7%).
The mean accuracy score was 1.78/3(59.3%), with significant differences between sources (HP: 2.35/3(78.5%), AHP: 1.53/3(51.0%), NHP:1.65/3(55.1%), UI: 1.63/3(54.3); p<0.001). Completeness scores averaged 2.1/5(42%), with content in English scoring higher [2.52/5(50.4%)] than Sinhala [2.05/5(40.97%)] and Tamil [2.17/5(43.33%)]. GQS averaged 2.4/5(48.4%). 82% of posts were classified as "Rotten" (<60% composite reviewer score for accuracy, completeness, and global quality). Content quality by platform was compared using ANOVA (mean) and Kruskal-Wallis (median) tests. Posts on Facebook and YouTube showed significantly higher completeness and GQS compared to other platforms (p<0.05).
User interaction analysis was conducted using both Pearson’s and Spearman’s correlation tests. There were no significant correlations observed between accuracy, completeness, or GQS and views or likes. Inter-reviewer variation was assessed using ANOVA and non-parametric tests. There was no statistically significant inter-reviewer variation in scoring patterns, indicating consistency within reviewer groups.

Conclusion

The majority of the SoMe content was from NHP sources. HP delivered the most accurate content. Facebook and YouTube emerged as platforms with relatively higher-quality content compared to others. Overall accuracy, completeness and GQS remained suboptimal across platforms. Most posts (82%) failed to meet adequate quality standards. Notably, user engagement metrics did not correlate with content quality. These findings highlight the need for improved quality control measures and health literacy initiatives to enhance the reliability of information regarding NAFLD on SoMe platforms.

Disclosure

All authors confirm no conflicts of interests to declare.

Clinical Case Summary

Background: Syphilis is a chronic systemic infection caused by the spirochete Treponema pallidum, often referred to as "the great imitator" due to its ability to affect nearly any organ. Syphilitic hepatitis, or "luetic jaundice," is a rare manifestation, indicating spirochete dissemination to the liver.
Case Report: A 26-year-old female was admitted to the hospital with fever (39.5 °C), fatigue, sweating, tremor, dark urine, pale stools, and significant weight loss (15 kg over two months). She also reported lower extremity muscle and joint pain, cough and slowing of speech. On examination, she had icteric skin, a generalized maculopapular rash, and enlarged cervical lymph nodes. No history of alcohol or drug use was noted.
Laboratory tests revealed elevated levels of both cytolytic and cholestatic liver enzymes, along with increased bilirubin an elevated C-reactive protein.
Abdominal ultrasound and contrast CT showed hepatomegaly, hilar and retroperitoneal lymphadenopathy and splenomegaly.
Viral hepatitis markers (HBsAg, HBV PCR, HCVAb, HCV PCR, anti-HAV IgM, anti-HEV IgM) and antibodies for CMV, EBV, HIV, HSV-1,2 were negative. Wright-Hedelson test for brucellosis and serological markers for autoimmune hepatitis were negative while IgG and cerulopasmin levels were within normal range. Given systemic findings and history, syphilis was considered. Serologic tests were positive for Treponema pallidum (ELISA, TPHA, MRP). Liver biopsy revealed mild active hepatitis. The diagnosis of ^secondary syphilitic hepatitis was made. The patient was started on antimicrobial therapy. During follow-up, liver function tests normalized, and systemic symptoms resolved.
Conclusion: This case underscores the importance of considering syphilis in the differential diagnosis of unexplained hepatitis. Although rare, syphilitic hepatitis should be considered in patients with liver enzyme elevations and nonspecific symptoms, particularly when no clear alternative diagnosis is found.

References

1) Malvar G, Cardona D, Pezhouh MK, Adeyi OA, Chatterjee D, Deisch JK, Lamps LW, Misdraji J, Stueck AE, Voltaggio L, Gonzalez RS. Hepatic Secondary Syphilis Can Cause a Variety of Histologic Patterns and May Be Negative for Treponeme Immunohistochemistry. Am J Surg Pathol. 2022 Apr 1;46(4):567-575. doi: 10.1097/PAS.0000000000001848. PMID: 34864775.
2)Supronowicz Ł, Rogalska M. Syphilitic hepatitis. Clin Exp Hepatol. 2024 Mar;10(1):9-13. doi: 10.5114/ceh.2024.136235. Epub 2024 Mar 12. PMID: 38765910; PMCID: PMC11100338.
3)Al Dallal HA, Narayanan S, Alley HF, Eiswerth MJ, Arnold FW, Martin BA, Shandiz AE. Case Report: Syphilitic Hepatitis-A Rare and Underrecognized Etiology of Liver Disease With Potential for Misdiagnosis. Front Med (Lausanne). 2021 Nov 29;8:789250. doi: 10.3389/fmed.2021.789250. PMID: 34912834; PMCID: PMC8666961.
Figure 1: Histological images of the liver biopsy
Figure 2: Abdominal CT images
Figure 3: Images of maculopapular rash

Introduction

Pharmacologic therapy is a key component of obesity management, either as standalone treatment or in conjunction with procedural interventions. The role of weight loss medications in the peri-ESG period remains unclear, with questions surrounding whether ESG reduces the need for pharmacotherapy or serves as a platform for combination therapy. Limited data exist on how prescribing patterns evolve before and after ESG in real-world settings. This study aims to evaluate the use of anti-obesity medications before and after ESG, focusing on patterns of pharmacologic initiation and its relationship to weight loss outcomes.

Aims & Methods

We conducted a retrospective review of 236 patients who underwent ESG at Singapore General Hospital between November 2020 and December 2025. All procedures were performed by a single experienced endoscopist using a U-shaped suturing pattern. For this analysis, we examined the use of anti-obesity medications before and after the ESG. Medications included GLP-1 receptor agonists, sympathomimetic agents, lipase inhibitors, and combination therapies. The primary outcome was the proportion of patients receiving pharmacotherapy across timepoints and its association with total body weight loss (%TBWL).

Results

Among the 236 ESG patients, 21.6% had previously used anti-obesity medications, most commonly GLP-1 receptor agonists or phentermine. This group consistently achieved the lowest total body weight loss (%TBWL) across all follow-up points. Compared to medication-naïve patients, their mean %TBWL was significantly lower at 6 months (9.9% vs 17.2%, p = 0.015), 12 months (7.8% vs 13.8%, p = 0.026), and 24 months (4.3% vs 10.6%, p = 0.003). These findings underscore the complexity of obesity care, as even patients exposed to multiple treatment modalities may continue to experience suboptimal outcomes.
After ESG, 37.7% of patients were initiated on pharmacotherapy, most commonly semaglutide (n = 66), including 38 on subcutaneous and 28 on oral formulations, with estimated mean doses of 1.63 mg/week and 13.2 mg/day, respectively. Phentermine and liraglutide were used in 13.9% and 3.0% of patients. Patients who received medications only after ESG had lower %TBWL at 6 months compared to those never on medications (14.0% vs 18.8%, p = 0.027), but outcomes were similar by 12 and 24 months. This suggests that pharmacotherapy may help support suboptimal early responders and mitigate longer-term differences.

Conclusion

Anti-obesity medications, particularly semaglutide, are commonly introduced after ESG to support patients with suboptimal early weight loss. While those requiring pharmacotherapy initially experienced less %TBWL, outcomes equalized by 12 months, suggesting a role for adjunctive treatment in slower responders. Patients who had previously used weight loss medications consistently achieved poorer outcomes, highlighting the challenges of obesity management even with multimodal therapy. These findings underscore the importance of individualized treatment strategies and the complementary role of pharmacotherapy alongside ESG in real-world practice.

Disclosure

​NIL

Introduction

The highest risk factor of inflammatory bowel disease (IBD) is having a first-degree relative (FDR) with IBD. However, genetic variation accounts for only a small proportion of IBD heritability. Evidence from family and twin studies underscores the role of shared environment for the development of IBD. In a recent study based on two population-based IBD cohorts from South-Eastern Norway, thirty years apart, we reported a substantial increase in the rate of familial IBD (1).

Aims & Methods

This study investigates the potential underlying mechanisms for the increased rate of familial IBD in South-Eastern Norway.
We examine the association between shared environment and gene expression across IBD phenotypes [Crohn’s disease (CD) and ulcerative colitis (UC)] and four comparison groups: (I) multiplex IBD familial patients (≥3 FDRs with IBD), (II) healthy relatives in multiplex IBD families, (III) sporadic IBD patients, and (IV) symptomatic non-IBD controls. Expression analyses focus on four candidate genes, FKBP5, BCL3, VMP1, and TRAIL, previously identified as differentially methylated in IBD compared to controls (2,3). Blood samples were collected from 15 multiplex IBD families in South-Eastern Norway, between April 2023 and January 2024. For comparison, blood samples from 50 sporadic IBD patients and 50 symptomatic controls (SC) were obtained from the IBSEN III cohort (4).
RNA was extracted from PAXgene blood samples of the multiplex families at EpiGen, Akershus University Hospital, Norway, while RNA extractions from the sporadic IBD patients and SCs were performed at The Institute of Clinical Molecular Biology, Kiel, Germany. All cDNA synthesis were carried out at EpiGen. Gene expression was measured using RT-qPCR on cDNA with target-specific primers. Relative quantification was performed using GAPDH and ACTB as housekeeping genes.
Simple t-tests were conducted to compare the mean gene expression between the four comparison groups and across IBD phenotypes.

Results

The multiplex IBD family study included 62 individuals, 41 IBD patients, 25 patients with UC, 16 with CD, and 21 healthy family members, 13 FDR and 8 spouses. The results for the differences in mean fold changes between the four groups, including CD and UC for each of the four candidate genes, are presented in Table 1. The gene expression analysis revealed differences in mean fold changes between the four groups and across CD and UC.
The relative quantification of gene expressions for the four candidate genes revealed no significant differences in gene expression among the IBD patients vs healthy members of multiplex families.
Significant differences were observed for all candidate genes among familial IBD vs sporadic IBD and between healthy multiplex family members vs symptomatic controls, except for BCL3 and TRAIL, respectively. (p<0.005).

Conclusion

Our results reveal associations between the expression levels of IBD candidate genes and shared family environment, suggesting that epigenetic mechanisms may contribute to the development of familial IBD. Further methylation studies are warranted to clarify the underlying mechanisms of changed gene expression.

References

1. Aabrekk TB. Increased familial risk of IBD over thirty years based on twopulation-based IBD incident cohorts conducted in South-Eastern Norway in 1990-1994 (IBSEN I) and in 2017-2019 (IBSEN III). [Abstract]. In press 2024.
2. Ventham NT, Kennedy NA, Adams AT, Kalla R, Heath S, O'Leary KR, et al. Integrative epigenome-wide analysis demonstrates that DNA methylation may mediate genetic risk in inflammatory bowel disease. Nat Commun. 2016;7:13507.
3. Joustra V, Hageman IL, Satsangi J, Adams A, Ventham NT, de Jonge WJ, et al. Systematic Review and Meta-analysis of Peripheral Blood DNA Methylation Studies in Inflammatory Bowel Disease. J Crohns Colitis. 2023;17(2):185-98.
4. Kristensen VA, Opheim R, Perminow G, Huppertz-Hauss G, Detlie TE, Lund C, et al. Inflammatory bowel disease in South-Eastern Norway III (IBSEN III): a new population-based inception cohort study from South-Eastern Norway. Scand J Gastroenterol. 2021;56(8):899-905.

Disclosure

Vendel A. Kristensen har reported scientific advisory boards from Takeda AS, consultant fees from Janssen-Cilag AS and speaker fees from Thermo Fisher Scientific.
Marte Lie Høivik has reported investigator-initiated research grants from Takeda, Pfizer, Tillotts, Ferring and Janssen. Speaker honoraria from Takeda, Tillotts, Ferring, AbbVie, Pfizer, Galapagos, MSD and Meda and Advisory board Takeda, Galapagos, MSD, Lilly, Janssen, Pfizer and AbbVie.
The other authors of this abstract have no Conflict of Interest