The rapid rise in GLP-1 prescriptions is reshaping obesity and metabolic disease management, but gastrointestinal specialists say the drugs also raise long-term questions for the field.
Five gastroenterologists recently connected with Becker’s to share their biggest concerns.
Editor’s note: Responses were lightly edited for clarity and length.
Question: In gastroenterology, what are your biggest long-term concerns with the soaring rates of GLP-1 prescription?
Gregory Churchill, DO. Gastroenterologist at Animas Surgical Hospital (Durango, Colo.):
This is a blockbuster medication with the real ability to treat chronic disease. I am sitting for the obesity medicine boards in October. My biggest concern is surrounding compounded medications. I see many patients with very serious GI side effects from the compounded versions with a lack of prescriber oversight.
Benjamin Levy, MD. Gastroenterologist at University of Chicago Medicine:
GLP-1 receptor agonists have revolutionized patients’ ability to lose weight and prevent obesity complications. They also help MASLD patients. But they slow gastric emptying and motility, leading to abdominal pain, constipation, diarrhea, nausea, gallstones and even pancreatitis. With prescriptions rising, we’ll see more of these side effects. They also impair colonoscopy prep, so physicians need individualized approaches. Long-term nutritional deficiencies and possible thyroid cancer risk are other concerns, even as evidence remains inconclusive.
Chris Magiera, MD. Advocate Aurora Oshkosh (Wis.) Medical Center:
The negative motility effects of GLP-1s are making it increasingly difficult to treat, prep and scope patients. They are becoming so ubiquitous that many patients don’t even report them as “medications,” which leaves GI physicians unprepared. This leads to cancellations, lost revenue, and delays in patient care.
Shaibal Mazumdar, MD. Gastroenterologist and Faculty Member at the Medical College of Wisconsin (Milwaukee):
With over 25 years of experience treating liver and GI disorders, I see the recent FDA approval of semaglutide (Wegovy) for noncirrhotic MASH with moderate to advanced fibrosis as a pivotal moment in hepatology. This expands treatment beyond weight loss and diabetes to directly address liver health. MASLD affects 30% of adults worldwide and can progress to cirrhosis or liver cancer. GLP-1s not only help patients lose weight, but also reduce liver fat, inflammation and fibrosis, potentially lowering cancer risk. While this is an exciting advance, it underscores the need for continued vigilance and long-term monitoring as these drugs are adopted more widely.
Neha Nigam, MD. Gastroenterologist at Inova Health System (Falls Church, Va.):
GLP-1 medications are reshaping weight loss and metabolic disease care, but from a GI perspective, long-term questions remain. I see patients with nausea, reflux, constipation and abdominal pain. What’s unclear is the impact of years of slowed motility or possible effects on the gallbladder and pancreas. I also worry patients may feel healthier and delay follow-up for conditions like fatty liver. These drugs are a major advance, but we’ll need to stay vigilant about their long-term effects.
