Esophageal Motility Patterns Are Not Impacted By Glucagon-Like Peptide-1 Receptor Agonist Use

Background: Glucagon-like peptide-1 receptor agonist (GLP-1RA) use is associated with delayed gastric emptying. It is unknown whether GLP-1RAs affect esophageal motility. We aimed to assess the relationship between GLP-1RA use and esophageal function test results. Methods: Patients with type 2 diabetes undergoing high-resolution manometry (HRM) between December 2022 and October 2024 were retrospectively evaluated, comparing cases with controls (on vs. off GLP-1RA). HRM diagnoses per the Chicago Classification 4.0 and reflux testing results were collected. Patients with prior foregut surgery and known conditions associated with dysmotility (eg, scleroderma) were excluded. Comparisons were performed using χ 2 and Mann-Whitney U tests for categorical and continuous measures, respectively. Results: There were 132 patients assessed and most (29/42, 69.0%) cases were female. Semaglutide was the most commonly used GLP-1RA (24, 57.1%) among cases, and the median A1c was the same (6.6%) for both cases and controls. Most GLP-1RA users (27, 64.3%) had a normal HRM and there was no significant difference ( P =0.07) in overall HRM diagnoses between cases and controls. There was no association ( P =0.51) between GLP-1RA type or dose and esophageal motility diagnoses. Among those undergoing formal reflux testing, there was no difference in detected rates of gastroesophageal reflux disease ( P =0.51) between cases and controls. Conclusion: We did not detect a statistically significant impact of GLP-1RA use on esophageal function assessed by formal testing among patients with type 2 diabetes. These results suggest that patients may continue GLP-1RAs when undergoing esophageal testing and are not at significantly increased risk for impacts on esophageal motility diagnosis compared with nonusers.