Ozempic and Wegovy Linked to Aspiration Pneumonia

Los Angeles, CA Patients who have undergone surgeries and endoscopies and taking weight-loss Ozempic, Wegovy and other GLP-1 medications risk aspiration pneumonia. A study conducted by researchers in California found that patients who underwent the procedure were 33 percent more likely to suffer the complication, which can be life-threatening.

The study was published in the medical journal Gastroenterology in April. Researchers analyzed data from nearly 1 million anonymous patients who had endoscopies between January 2018 and December 2020. Dr. Ali Rezaie, medical director of the GI Motility Program at Cedars-Sinai Medical Center said, 'Aspiration during or after endoscopy can be devastating…If significant, it can lead to respiratory failure, ICU admission and even death. Even mild cases may require close monitoring, respiratory support and medications including antibiotics.' Rezaie emphasized the importance of taking all possible precautions to prevent aspiration from occurring. 'When we apply this risk to the more than 20 million endoscopies that are performed in the US each year, there may actually be a large number of cases where aspiration could be avoided if the patient safely stops their GLP-1RA medication in advance,” he said.

The study looked at data from 2018 to 2020, when Ozempic had already been on the market, but before the latest GLP-1 treatments like Wegovy, Mounjaro, and Zepbound were approved. According to STAT News, the researchers found that among people undergoing upper endoscopies, GLP-1 drug users had an 48% higher risk of aspiration pneumonia, and for combined upper endoscopies and colonoscopies, they had more than double the risk. The researchers did not find a higher risk among people getting only colonoscopies. It reported that, despite the study’s reliance on health records, the researchers could not confirm how consistently patients were taking GLP-1 drugs before the procedures. Also, they included cases of aspiration pneumonia that occurred within a month of the procedures, but had no way of confirming whether the infection necessarily stemmed from the procedures.

Aspiration Pneumonia

According to the Cleveland Clinic, aspiration pneumonia is caused by something other than air being inhaled (aspirated) into your respiratory tract. These non-air substances can be food, liquid, saliva, stomach contents, toxins or even a small foreign object. Symptoms include shortness of breath, wheezing, coughing up blood or pus, chest pain, bad breath, and extreme tiredness. 

Aspiration of food or drink is quite common and likely happened to you. When people say that food "went down the wrong pipe,” it means that food or drink went toward your lungs instead of your stomach. When this happens, you probably coughed until you felt better. When the same sort of thing happens to someone who isn’t able to cough the food or drink out of their lungs, aspiration pneumonia may result.

The prognosis for aspiration pneumonia also depends on your overall health and other conditions that you may have and how sick you were when you started treatment. Untreated aspiration pneumonia can result in serious complications like lung abscesses or lung scarring. And it can result in death.

It can be treated with appropriate medications. If left untreated, complications can be serious, even fatal but most people who get aspiration pneumonia and get treatment will survive. However, it kills about 58,000 Americans per year, according to 2022 data.  That number could increase, given the wildly popular weight-loss drugs. The study looked at data from 2018 to 2020, when Ozempic had already been on the market, but became popular around 2022 and before the latest GLP-1 medications like Wegovy, Mounjaro, and Zepbound were approved.

Endoscopy

An endoscopy is a minimally invasive procedure used to look inside the body – to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inserted directly into the organ from an opening in the body such as the mouth or anus. Rezaie said that GLP-1 medications may lead to aspiration pneumonia ahead of an endoscopy because the drugs slow digestion, which makes food sit in the stomach longer. As a result, the stomach may not be completely empty while a patient fasts, which is required before an endoscopy to get a clear picture. This could cause choking because while a person is under general anesthesia, contents from the stomach may move up to the mouth and enter the trachea and the lungs. 
More than 20 million endoscopies are performed in the U.S. each year.

Andrew Wang, chief of the division of gastroenterology and hepatology at University of Virginia who was not involved in the study, said, “This study is important as we need more data about the possible consequences for patients using [GLP-1 drugs] prior to GI endoscopy.” The study’s findings came on the heels of a July 2023 warning announced by the American Society of Anesthesiologists, regarding potential Ozempic surgical aspiration risk. It advised that patients should stop taking GLP-1 medications before any medical procedure involving anesthesia. The warning indicated the drugs carry an increased risk of regurgitation and aspiration of food while under deep sedation.