S737 Risk of GERD and Psychological Symptoms in Patients Using GLP-1 Agonist and DPP-4 Antagonist vs Gastric Bypass Surgery Recipients

Introduction: The use of weight-loss medications, including glucagon-like peptide-1 (GLP-1) agonists and dipeptidyl peptidase 4 (DPP-4) antagonists, has increased in recent years as an alternative to traditional weight-loss methods. However, it carries potential side effects, including gastroesophageal reflux disease (GERD) and psychological symptoms, such as anxiety and depression. Gastric bypass surgery is an alternative that offers a more permanent solution for weight loss, which reduces the size of the stomach and reroutes part of the digestive system to limit food intake and nutrient absorption. This study aims to evaluate and compare the risk of developing GERD and psychological symptoms in patients who take GLP-1 agonists and DPP-4 antagonists versus those who undergo gastric bypass surgery. Methods: A retrospective database analysis was conducted using the multi-institutional database TriNetX. We looked at adults (>18 years) who have taken GLP-1 agonists and DPP-4 antagonists (cohort A) versus those who have undergone gastric bypass (cohort B) and their risk of GERD. Propensity score matching was done to ensure balanced demographic and clinical characteristics, which generated 110,737 matched patients in each cohort. Statistical analysis calculated risk ratios, 95% confidence interval (CI) with significance set at P < 0.05. Results: After 1 month, gastric bypass recipients had a slightly higher prevalence of GERD (risk difference [RD]: 0.014, 95% CI of risk ratio [RR]: [0.331, 0.404], RR: 0.366, P ≤ 0.001). At 6 months, they experienced increased risks of GERD (RD: 0.034, 95% CI RR: [0.498, 0.548], RR: 0.522, P ≤ 0.001), anxiety (RD: 0.010, 95% CI RR: [0.704, 0.784], RR: 0.743, P ≤ 0.001), and depression (RD: 0.015, 95% CI RR: [0.604, 0.676], RR: 0.639, P ≤ 0.001). By 1 year, these risks persisted, with GERD (RD: 0.042, 95% CI RR: [0.571, 0.616], RR: 0.593, P ≤ 0.001), anxiety (RD: 0.010, 95% Cl RR: [0.800, 0.868], RR: 0.833, P ≤ 0.001), and depression (RD: 0.018, 95% CI RR: [0.682, 0.744], RR: 0.713, P ≤ 0.001) remaining significant. Conclusion: There was a significant association indicating an elevated risk of GERD and psychological outcomes following the gastric bypass procedure. A mechanism that could explain this would be how gastric bypass alters the anatomy of the stomach and the esophagus, which can lead to bile reflux and changes in lower esophageal sphincter function, resulting in worse cases of GERD. Additional research is needed to optimize patients' choice between gastric bypass and GLP-1 agonist and DPP-4 antagonist.