S972 GLP-1 Use in the Obese Population and the Development of Barrett's Esophagus in a Rural State

Introduction: Obesity is a well-documented risk factor for gastroesophageal reflux disease (GERD) and Barrett’s esophagus (BE), a premalignant condition associated with esophageal adenocarcinoma. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), widely used for weight management and glycemic control, may influence esophageal pathology by altering gastric emptying and worsening reflux of gastric acids into the lower esophagus. However, their impact on the development of BE, in this population, remains unclear. Methods: The electronic medical record database in a single academic center was retrospectively queried for all obese patients on GLP-1 RA medication from January 2017 to December 2023. Data included demographic variables, patients’ home counties, the type of GLP-1 medications each patient had taken, and BE rates. The patient’s home county was classified as rural or non-rural based on whether or not the county was part of a metropolitan area (MA), as designated by the Office of Management and Budget. Univariate and bivariate analyses were conducted to determine if there were significant differences between rural and non-rural cohorts in demographics and in development of BE with statistical significance defined as P < 0.05. Results: Altogether 5,367 obese patients with GLP-1 RA use were included in the study. The average age was 53.6 (standard deviation = 13.5), the cohort was mostly women (73.0%), and predominantly White (51.5%). The rate of BE was 0.4% (N = 21) in this cohort, which is significantly lower than previously reported rates in this type of patient cohort (1.9%; P < 0.01) (Bashar J, et al.). There was no statistically significant difference in incidence of BE between rural and non-rural patients (0.3% vs 0.4%; P = 0.751). Of the patients that did develop BE, the majority were on semaglutide (N = 11, 52.4%). Conclusion: In this retrospective study, GLP-1 RAs appeared to be associated with a reduced risk of developing BE in obese patients, potentially through weight loss and subsequent improvements in GERD symptoms. These findings support further prospective studies to elucidate the mechanistic link between GLP-1 therapy and esophageal health.