Health Rounds: No need to stop 1 drugs before surgery for most patients
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By Nancy Lapid
Oct 31 (Reuters) -Hello Health Rounds Readers! Today we feature three studies from this week's American College of Gastroenterology meeting in Philadelphia, including one with important implications for those taking popular GLP-1 drugs to lose weight or for diabetes.
Most patients don't need to stop GLP1 drugs before surgery
In a practice-changing guideline reversal, medical societies advised on Tuesday that most patients do not need to stop taking GLP-1 diabetes and weight-loss drugs before surgery, a ruling supported by a study presented this week at a medical meeting of gastrointestinal doctors.
The study also suggests that patients might benefit from following a clear liquid diet for a day in advance, although that was not included in the new guidelines.
Patients typically fast before undergoing anesthesia in order to empty the stomach. An empty stomach allows for better examination via endoscopy and lowers the risk of aspiration, a life-threatening complication involving inhalation of gastric contents.
Because GLP-1 drugs such as Novo Nordisk's NOVOb.CO Ozempic and Wegovy and Zepbound and Mounjaro from Eli Lilly LLY.N slow stomach emptying, surgeons had been requiring patients to stop those drugs well in advance of anesthesia in order to ensure an empty stomach.
But a new review of 35 studies involving more than 714,000 patients undergoing upper-gastrointestinal endoscopy found no extra risk of aspiration in patients who had not paused their use of GLP1 drugs beforehand.
They were compared with patients who either were not using the drugs or were using them but had stopped them well in advance of surgery.
The findings were presented by Dr. Violeta Popov of NYU Langone Health NY VA Harbor Health System on Wednesday at the American College of Gastroenterology meeting in Philadelphia.
Procedures more often had to be stopped early in patients who had not stopped the GLP-1 drugs, possibly because significant amounts of food remained in the stomach, her team found. However, retained gastric contents were not a problem in a subset of patients taking GLP1 drugs who had been on a liquid diet for 24 hours because they were scheduled for colonoscopy.
Therefore, the researchers suggest, it might be best to follow a 24-hour clear liquid diet prior to GI endoscopy without discontinuing GLP1 therapy.
Esophagus cancer precursor being seen at younger ages
A pre-malignant condition of the esophagus is becoming more common at younger ages, researchers have found, suggesting potential benefits from earlier screening.
Barrett's esophagus is usually diagnosed around age 60, but a new study of more than 2.6 million patients found a significantly increasing trend of young-onset Barrett’s esophagus from 2014 to 2023, researchers reported at the gastroenterology meeting.
In Barrett's esophagus, stomach acid has damaged the lining of the lower esophagus, increasing the risk for cancer.
Treatment may include medicines and surgery. Patients with mild cases are advised to undergo endoscopy on a regular basis to monitor the cells in the esophagus lining.
In the new study, 20% of participants had been diagnosed before age 50, with early-stage disease in nearly all cases.
Risk factors in younger patients were similar to those in older patients, including hiatal hernia, gastrointestinal reflux, smoking, and high body mass index, Dr. Anila Vasireddy of the University of Pennsylvania Health System reported.
“Our study validates that conventional risk-factors of Barrett’s esophagus in older patients also predict young-onset Barrett’s esophagus,” her team said in a written summary.
“Screening... before the age of 50 may have a significant impact on early detection of esophageal adenocarcinoma,” they said.
U.S. patients undertreated for alcohol use disorder
Drug treatment of alcohol use disorder is underused in U.S. patients and particularly in patients with alcoholic liver disease, researchers reported at the Philadelphia gastroenterology meeting.
Pharmacotherapy is an important tool for treating addiction and preventing progression of liver disease. But among 26,985 commercially insured patients with alcohol use disorder who did not have liver disease, only 14.5% had been prescribed medication. That rate dropped to 2.3% among 1,201 alcohol abuse patients with liver disease, the researchers said.
Patients with the most severe alcoholic liver disease had the lowest odds of receiving drug therapy for their alcoholism, Dr. Alex Jones of the University of Texas Southwestern Medical Center reported.
Gabapentin was the most commonly prescribed medication in the study, followed by oral naltrexone and topiramate.
“Providers caring for patients with alcoholic liver disease should consider this underutilized therapy, or refer for psychiatric consultation when appropriate,” the researchers said.
Reporting by Nancy Lapid; Editing by Bill Berkrot
تازہ ترين خبريں
دستبرداری: XM Group کے ادارے ہماری آن لائن تجارت کی سہولت تک صرف عملدرآمد کی خدمت اور رسائی مہیا کرتے ہیں، کسی شخص کو ویب سائٹ پر یا اس کے ذریعے دستیاب کانٹینٹ کو دیکھنے اور/یا استعمال کرنے کی اجازت دیتا ہے، اس پر تبدیل یا توسیع کا ارادہ نہیں ہے ، اور نہ ہی یہ تبدیل ہوتا ہے یا اس پر وسعت کریں۔ اس طرح کی رسائی اور استعمال ہمیشہ مشروط ہوتا ہے: (i) شرائط و ضوابط؛ (ii) خطرہ انتباہات؛ اور (iii) مکمل دستبرداری۔ لہذا اس طرح کے مواد کو عام معلومات سے زیادہ کے طور پر فراہم کیا جاتا ہے۔ خاص طور پر، براہ کرم آگاہ رہیں کہ ہماری آن لائن تجارت کی سہولت کے مندرجات نہ تو کوئی درخواست ہے، اور نہ ہی فنانشل مارکیٹ میں کوئی لین دین داخل کرنے کی پیش کش ہے۔ کسی بھی فنانشل مارکیٹ میں تجارت میں آپ کے سرمائے کے لئے ایک خاص سطح کا خطرہ ہوتا ہے۔
ہماری آن لائن تجارتی سہولت پر شائع ہونے والے تمام مٹیریل کا مقصد صرف تعلیمی/معلوماتی مقاصد کے لئے ہے، اور اس میں شامل نہیں ہے — اور نہ ہی اسے فنانشل، سرمایہ کاری ٹیکس یا تجارتی مشورے اور سفارشات؛ یا ہماری تجارتی قیمتوں کا ریکارڈ؛ یا کسی بھی فنانشل انسٹرومنٹ میں لین دین کی پیشکش؛ یا اسکے لئے مانگ؛ یا غیر متنازعہ مالی تشہیرات پر مشتمل سمجھا جانا چاہئے۔
کوئی تھرڈ پارٹی کانٹینٹ، نیز XM کے ذریعہ تیار کردہ کانٹینٹ، جیسے: راۓ، خبریں، تحقیق، تجزیہ، قیمتیں اور دیگر معلومات یا اس ویب سائٹ پر مشتمل تھرڈ پارٹی کے سائٹس کے لنکس کو "جیسے ہے" کی بنیاد پر فراہم کیا جاتا ہے، عام مارکیٹ کی تفسیر کے طور پر، اور سرمایہ کاری کے مشورے کو تشکیل نہ دیں۔ اس حد تک کہ کسی بھی کانٹینٹ کو سرمایہ کاری کی تحقیقات کے طور پر سمجھا جاتا ہے، آپ کو نوٹ کرنا اور قبول کرنا ہوگا کہ یہ کانٹینٹ سرمایہ کاری کی تحقیق کی آزادی کو فروغ دینے کے لئے ڈیزائن کردہ قانونی تقاضوں کے مطابق نہیں ہے اور تیار نہیں کیا گیا ہے، اسی طرح، اس پر غور کیا جائے گا بطور متعلقہ قوانین اور ضوابط کے تحت مارکیٹنگ مواصلات۔ براہ کرم یقینی بنائیں کہ آپ غیر آزاد سرمایہ کاری سے متعلق ہماری اطلاع کو پڑھ اور سمجھ چکے ہیں۔ مذکورہ بالا معلومات کے بارے میں تحقیق اور رسک وارننگ ، جس تک رسائی یہاں حاصل کی جا سکتی ہے۔
