S997 Examining the Effects of GLP-1 Receptor Agonist Therapy on Esophageal Motility Through High Resolution Esophageal Manometry (HREM)

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are medications used in the treatment of obesity and type 2 diabetes. They cause delayed gastric emptying and increase gastrointestinal side effects, however their impact on esophageal motility is not well understood. We aimed to determine if GLP-1 RAs have a significant effect on esophageal motility compared to equivalent second-line diabetes medications (OSLT2DM). Methods: We queried the MetroHealth database using the TriNetX network to identify patients who had T2DM or who had a body mass index (BMI) ≥27 (2006-2025) who initiated Cohort 1) GLP-1 RA or Cohort 2) OSLT2DM, excluding esophageal motility disorders and major upper abdominal surgery. We extracted high-resolution esophageal manometry (HREM) reports with dates of prescription initiation and refills. For Cohort 1, reports were extracted during active GLP-1 RA use; for Cohort 2, from OSLT2DM initiation until GLP-1 RA initiation or date of query. Patient demographics, BMI, hemoglobin A1c, HREM report indication, diagnoses and metrics were extracted. Statistical comparisons were done using t tests, with Bonferroni correction for multiple testing. Results: Cohort 1 had 31 patients while Cohort 2 had 28. Cohort 1 average age was 62.5 ± 5.8 years, with an average BMI of 34.7 ± 8.1 kg/m², and an average A1c of 8.29 ± 2.09%. Cohort 2 had an average age of 68.5 ± 11.6 years, with an average BMI of 30.2 ± 5.9 kg/m², and an average A1c of 8.01 ± 2.15%. Overall, 67.7% of Cohort 1 and 71.4% of Cohort 2 underwent HREM for dysphagia while 16.1% of Cohort 1 and 14.3% of Cohort 2 were evaluated for reflux. Normal motility was significantly more common in Cohort 1 (61.3% vs 28.6%; P = 0.02) while ineffective esophageal motility was more prevalent in Cohort 2 (6.5% vs 25%; P = 0.07), though not statistically significant. HREM data showed no significant differences in lower esophageal sphincter integrated relaxation pressure (14.4 ± 12.3 vs 10.2 ± 22.5; P = 0.385), distal latency (7.45 ± 2.04 vs 9.42 ± 9.15; P = 0.274) and distal contractile integral (2,201 ± 1,636 vs 1,599 ± 1,431; P = 0.137). Weak swallows were more common in the control group (0.32 ± 0.60 vs 1.97 ± 3.07; P = 0.009; corrected P = 0.065), though not significant after Bonferroni correction. Conclusion: Our findings indicate that GLP-1 RA exposure does not significantly affect esophageal motility or sphincter pressures. Despite their association with gastroesophageal reflux disease, GLP-1 RAs likely act via delayed gastric emptying rather than affecting esophageal motility, warranting further research.