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

Obesity and type 2 diabetes mellitus (T2DM) represent growing global health challenges, affecting millions of individuals worldwide. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as a cornerstone in the management of both conditions due to their metabolic benefits, including weight loss and glycemic control. European cohort studies have reported a high prevalence of gastrointestinal symptoms – including nausea, vomiting and early satiety among patients using GLP-1RAs. In parallel, increased rates of residual gastric content (RGC) during upper endoscopy have raised safety concerns, prompting reevaluation of pre-procedural fasting guidelines. However, data on the effects of GLP1-RA on the gastrointestinal (GI) tract in Asian patients is limited.

Aims & Methods

Our primary aim was to characterize a cohort of patients who received treatment with GLP1-RA in terms of their gastrointestinal side effects and presence of RGC during upper endoscopy. The secondary objective was to compare the afore-mentioned variables between 2 groups: oral versus subcutaneous mode of administration. We conducted a retrospective cross-sectional cohort study of 139 Asian adult patients with T2DM and/or obesity who were prescribed GLP-1RAs at a tertiary hospital between 01 January 2022 to 01 January 2023. Data collected included demographics, anthropometric measurements, co-morbidities, GI symptoms and upper endoscopy findings. Upper endoscopy images were analysed and adequacy of mucosal visibility was graded using the POLPREP scale. Patients were further stratified into two subgroups based on route of GLP-1RA administration: oral versus subcutaneous. Statistical analysis compared symptom prevalence and POLPREP scores across subgroups using chi square test, with p <0.05 considered statistically significant.

Results

A total of 139 patients were analysed. 19.4% of patients had GLP-1RA prescribed for T2DM, 21.6% for Obesity, and 58.8% for both. The most commonly prescribed GLP-1RA was Liraglutide (33.8%) followed by oral Semaglutide (28.1%). Majority of patients (66.9%) did not have any GI side effects. The most commonly reported GI symptoms were abdominal bloating (15.8%), nausea (7.9%) and early satiety (4.3%). 13.7% of patients underwent upper endoscopy with 89.5% having a POLPREP score of 3 with no significant complications reported. None of the patients withheld GLP-1RA prior to endoscopy. Upon stratifying patients based on route of administration, analysis revealed that patients on oral GLP-1RAs were more likely to report nausea compared to those on subcutaneous formulations (15.8% vs 5.0%, p=0.03). There were no significant differences in the other GI symptoms or POLPREP scores.

Conclusion

Based on our Asian cohort, these findings suggest that GLP-1RAs have an acceptable GI symptom profile with a potential route-dependent difference in symptomatology. In addition, discontinuing these drugs prior to upper endoscopy may be unnecessary.

References

1. Camilleri et al. Effects of GLP-1 and other Gut Hormone Receptors on the Gastrointestinal tract and implications in clinical practice. Am J Gastroenterol 2024;119:1028-1037
2. Nadeem et al. Effects of glucagon-like peptide-1 receptor agonists on upper endoscopy in diabetic and nondiabetic patients. Gastrointestinal Endoscopy 2024.
3. Jalleh et al. Gastrointestinal effects of GLP-1 receptor agonists: mechanisms, management, and future directions. Lancet Gastroenterol Hepatol 2024;9:957-64
4. Facciorusso et al. Effects of Glucagon-like peptide-1 receptor agonists on upper gastrointestinal endoscopy: A meta-analysis. Clinical Gastroenterol and Hepatol 2024.
5. Romańczyk et al. Scoring system assessing mucosal visibility of upper gastrointestinal tract: The POLPREP scale. J Gastroenterol Hepatol 2022 Jan;37(1):164-168.

Disclosure

Nothing to disclose

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