{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:04:14Z","timestamp":1790708654196,"version":"4.1.0"},"reference-count":76,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101 RAs) and dual glucose\u2010dependent insulinotropic polypeptide (GIP)\/GLP\u20101 receptor agonists have transformed the management of type 2 diabetes and obesity. Gastrointestinal (GI) adverse events are the most common limitation of these therapies and a leading cause of discontinuation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This narrative expert review synthesizes evidence from randomized controlled trials, observational studies, meta\u2010analyses, and pharmacovigilance data to characterize the incidence, mechanisms, and clinical implications of GI adverse effects across approved agents and late\u2010stage pipeline therapies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nausea, vomiting, diarrhea, and constipation are established class effects, occurring in approximately 30%\u201350% of patients, typically during initiation and dose escalation. These events are generally mild to moderate and manageable with dose titration and dietary modification. Mechanisms include delayed gastric emptying, central activation of emetic pathways, altered intestinal motility, and physiologic effects of rapid weight loss itself. Randomized trial data are reassuring for acute pancreatitis, with no class\u2010level excess risk demonstrated; pharmacovigilance signals are most plausibly explained by diagnostic misclassification rather than true causal risk. Cholelithiasis shows a probable class\u2010level association, substantially mediated by weight loss rather than direct receptor signaling. Peri\u2010procedural data show increased residual gastric volume without confirmed aspiration events. Preliminary data on late\u2010stage pipeline agents (retatrutide, survodutide, and cagrilintide\u2010semaglutide) suggest a similar GI adverse event profile to approved agents, though evidence remains largely limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GI adverse events with GLP\u20101\u2010based therapies are predictable and manageable. A proactive, patient\u2010centered approach is essential to optimize adherence, safety, and clinical outcomes as newer agents expand the therapeutic landscape.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ncp.70180","type":"journal-article","created":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:13:56Z","timestamp":1790705636000},"page":"1318-1333","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gastrointestinal adverse effects of GLP\u20101 receptor agonists and dual GIP\/GLP\u20101 receptor agonists: A narrative expert review of approved therapies, oral formulations, and pipeline agents"],"prefix":"10.1002","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6063-1558","authenticated-orcid":false,"given":"Vikash","family":"Singhani","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Ehsan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Valencia","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Nadeem","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisha","family":"Moazzam","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine King Edward Medical University Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winfield Scott","family":"Butsch","sequence":"additional","affiliation":[{"name":"Department of Surgery Digestive Disease Institute, Cleveland Clinic Cleveland Ohio USA"},{"name":"Department of Internal Medicine and Geriatrics Primary Care Institute, Cleveland Clinic Cleveland Ohio USA"},{"name":"Novo Nordisk Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2493-1881","authenticated-orcid":false,"given":"Samita","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Hepatology and Nutrition, Digestive Disease Institute, Cleveland Clinic Cleveland Ohio USA"},{"name":"Case Western Reserve University School of Medicine Cleveland Ohio 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