Acid reflux/GERD worsening on GLP-1 — PPI interaction data

Dr.GastroMayo said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

Dr.GastroMayo has the substance of this right. The condition it depends on is worth stating. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

That is the short version; the long version is somebody else's post.

Dr.GastroMayo said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

I dislike how confidently this board tells people to push through. Incidence figures around 20 to 25% at the higher doses are class-typical, but the trials also had a discontinuation column, and "manageable with protocols" is not the same as manageable for everyone.

This one has a reasonably settled answer, so here it is. The practical protocol is dull and it works: smaller meals, stop eating at the first sign of fullness rather than at the end of the plate, drop the fat fraction of meals in the two days after dosing, and do not lie down straight after eating. Most of what people call unmanageable nausea is a meal-size and meal-composition problem interacting with a stomach that is emptying slowly.

Dr.SurgeonPGH said:

The line between titrate-through and stop is not severity, it is trajectory and what else is present.

Same pattern here, and in the same order.