“GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern”

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A Banks. N Engl J Med 2026;394:1665-1667. GLP-1 Receptor Agonists and Eating Disorders — Cause for Concern.

An excerpt:

Constraining the growth of the global obesity epidemic would have clear benefits at the individual and population levels. Use of GLP-1 drugs has been linked in some patients to improved cardiovascular outcomes, a reduced risk of kidney disease, a reduced desire to drink alcohol, and potentially protective effects against neurodegenerative diseases. It is therefore easy to understand the substantial interest in investing in the development of these products and the optimism about their public health effects.

Nonetheless, some worrisome signals have emerged…The proportion of GLP-1 receptor agonist prescriptions that were written for people without diabetes, obesity, or overweight increased from 4.5% in 2018 to 17% in 2023…1

There is also compelling preliminary evidence suggesting that the use of these drugs could exacerbate and lead to new diagnoses of restrictive eating disorders, including anorexia nervosa…3 Lifetime prevalence of anorexia nervosa is as high as 6.3% in women and 0.3% in men,4 and the risk of death from any cause among people with anorexia nervosa is more than five times as high as that in the general population…5

Nutrient deficiencies, electrolyte abnormalities, orthostatic hypotension, osteopenia, sarcopenia, thinning hair, and other signs of malnutrition have been observed [in users of GLP-1 agents], and the effects of long-term use are still largely unknown…

The cumulative incidence of new eating-disorder diagnoses (most commonly anorexia nervosa) in the full study population was 1.275%…3 this proportion translates to more than 420,000 people who could develop a related eating disorder with long-term use.

Physicians, trialists, regulators, policymakers, and drug developers are unprepared for this coming wave.

My take: GLP-1 RAs are not for everybody; they will likely contribute to eating disorders in many patients.

GLP-1 RAs also have been associated with a higher risk of Nonarteritic Anterior Ischemic Optic Neuropathy (aka ‘eye stroke’) in approximately in 1 in 10,000 recipients. One reference: JAMA Ophthalmology. 2026;144;(3):259-264. New-Onset Nonarteritic Anterior Ischemic Optic Neuropathy and Initiators of Semaglutide in US Veterans With Type 2 Diabetes

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Beneficial Off-Target Effect: Upadacitinib Improved Eosinophilic Esophagitis (Case Report)

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N Nguyen , M Bauer. JPGN Rep. 2026;1-3.  Successful treatment of eosinophilic esophagitis with upadacitinib prescribed for atopic dermatitis. doi:10.1002/jpr3.70170

This case report describes a 15 yo with severe atopic dermatitis and multiple atopic diseases whose eosinophilic esophagitis remained in remission after starting upadacitinib, a JAK1 inhibitor, and stopping dupilumab. JAK1 inhibitors, such as upadacitinib and abrocitinib, are approved for severe AD. 

The discussion notes that there had been a prior case report of tofacitinib, a JAK1/JAK3 inhibitor, effectively treating refractory EoE. The authors “hypothesize that JAK inhibition of key Th1 and Th2 signaling pathways including IL-4, IL-13, and TSLP could effectively treat EoE, while also treating AD.”

My take (borrowed from authors): “If upadacitinib is used for the treatment of AD, cessation of other therapies for EoE, particularly biologics like dupilumab, should be strongly considered.”

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AI Pilot Prescription Renewal in Utah

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S Gerke et al. NEJM 2026; 394: 1561-1563. Utah’s Prescription-Renewal Pilot Program — Autonomous AI Managing Patient Care

An excerpt:

In January 2026, Utah rolled out a 12-month pilot program involving an AI system developed by health tech startup Doctronic that autonomously renews certain prescriptions for people with chronic conditions…1,2

Although the program is limited to prescription renewals for 192 commonly prescribed drugs (see box),1,2 it could pave the way for expanded initiatives that include additional products, autonomous initial prescribing, and broader geographic areas…

One question is whether it targets a clinically meaningful problem. The stated purpose is to address medication nonadherence…Automated medication-refill programs for various classes of drugs, including antihypertensives, lipid-lowering agents, and antidiabetic agents, have meaningfully increased adherence…4

Autonomous renewal would be inappropriate for medications requiring frequent dose adjustments or in patients whose clinical status could change rapidly…physician oversight to detect early signs of toxic effects, disease progression, or changing organ function that would necessitate dose modification…AI-based refill generation without a defined end point may preclude opportunities for physician–patient discussions that could curb polypharmacy or medication overuse.

The Utah program could also present legal problems. Doctronic’s AI system, which reportedly hasn’t been reviewed by the Food and Drug Administration (FDA),1 should probably be considered a device under the Federal Food, Drug, and Cosmetic Act (FDCA)…

Another FDCA provision specifies that dispensing a prescription drug constitutes misbranding — a violation carrying potential civil or criminal penalties — unless it occurs “upon a written prescription of a practitioner licensed by law to administer such drug” or upon an oral order that is promptly turned into a written order by the pharmacist…

It is unclear whether Utah’s AI system complies with these requirements. Even if Utah allows AI-based prescribing in the absence of supervision by a licensed physician or other prescriber, federal law would preempt state law…

The FDA may decide to look the other way and allow this experiment to continue, leaving clinicians and patients without safety assurances amid an extraordinary expansion of autonomy for AI.

My take: There may be many situations in which agentic AI would be helpful with pharmacy management. However, until this technology is proven to be safe, like all other devices, it should be limited to situations in which the prescribing physician is in agreement with this process.

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Peony (blooms here in late April)

The Mother of Invention: Central Line Vest to Reduce Complications

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RE St Pierre-Hetz et al. JPGN Reports. 2026;1–6. A novel central line securement vest reduces line trauma and improves quality of life in patients with intestinal failure

This single center study compared a novel central line securement vest (n=12) to traditional securing methods (n=11).

Key findings:

  • The vest group had lower rates of line trauma during the period of vest use versus prior to its use. The rates of infections and replacements were a little lower during vest use (not statistically-significant) compared to prior to use. The control group had similar rates of trauma, infections, and replacements before and during the study period.
  • The vest group had much higher rates of line issues prior to vest use than the control group
  • 5 of the 12 vest patients discontinued use before the planned 12-month evaluation

The story behind the inventor is fascinating as well. “Gus Gear” was “founded by Sarah Palya over a decade ago after her son Gus was diagnosed with intestinal failure.” Due to this, he required long-term parenteral nutrition. “Gus also has autism, and his constant movement and activity put him at risk for accidental line trauma and infection. Sarah looked for ways to secure his central line while also allowing him to live as normally as possible, without severely restricting his activity. Finding no solutions, she sat down at her sewing machine and created the very first Gus Gear Central Line Vest to secure his catheter.” The company now makes a similar product to secure GTubes, LOCK 3000 Belt.

My take: This small study supports the use of this product, especially in those prone to line trauma: Gus Gear Central Line Vest® (Dr. Hochman has no commercial ties to this company)

Origin of the expression: “Necessity is the mother of invention“

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Proactive Therapeutic Drug Monitoring is Routine Part of Pediatric IBD Care Plus SNL Humor

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RJ Colman et al. Crohn’s & Colitis 360, Volume 7, Issue 3, July 2025, otaf050. https://doi.org/10.1093/crocol/otaf050. Open Access! Therapeutic Drug Monitoring in Pediatric Inflammatory Bowel Disease: A Nationwide Survey of Anti-TNF Therapy Practices, Attitudes, and Barriers 

Methods: A 28-item survey of therapeutic drug monitoring (TDM) was deployed through the ImproveCareNow Learning Health System Network between February and June 2023.

Key findings:

  • Among 380 invitees, 256 (77%) completed the questionnaire. Among respondents, 67% (171) were academic-affiliates
  • In contrast to the adult literature, most pediatric gastroenterologists report undertaking proactive TDM for anti-TNF agents in IBD management
  • TDM: All 256 respondents reported using TDM for infliximab, while 252 (98%) used TDM for adalimumab (ADL)
  • Proactive TDM: Proactive TDM was more common for infliximab 98% (205/256) compared to ADL 92% (232/252; P = .0007)
  • Overall, 61% (156/255) of respondents reported that they experienced barriers in undertaking TDM. Insurance denial (50%) and cost (31%) were the 2 most commonly reported barriers
Frequency of therapeutic drug monitoring use stratified by anti-TNF agent.

Limitation: Only surveyed practitioners in ICN. However, “approximately 65% of US pediatric gastroenterologists practice within ICN-affiliated institutions, [thus] our findings likely reflect national trends.”

My take (borrowed from authors): “Proactive TDM, is a widely practiced strategy, and represents the current standard of care among pediatric gastroenterologists in the United States.” 

How to explain a complication with Will Ferrell, YouTube Link: SNL Post-Op (5 minutes)

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What to Make of Popular “Liver Detox” Therapies

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An excerpt:

A cross-sectional study of the 20 highest-ranked purported “liver-cleansing” products sold on Amazon found that they generated almost $40 million in annual revenue, yet their detoxification claims and ingredients were unsupported by data and, in some cases, these products caused adverse events…evidence assessment showed that even the most common ingredients have limited scientific support.

The most common ingredient in the analyzed products was milk thistle, which appeared in 19 of 20 products. This was followed by dandelion root (13) and turmeric root (13). Other, less common ingredients included zinc (12), beetroot (11), artichoke extract (10), choline (10), ginger (9), chicory (8), and berberine (7)…

The investigators recommended “several policy improvements, including mandatory pre-market safety testing, standardized manufacturing practices, enhanced post-market surveillance, and requirements for scientific substantiation of marketing claims.”

My take: Herbal and dietary supplements can cause drug-induced liver injury, sometimes life-threatening. It would be best for those who claim these products are effective to provide proof of this.

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Management of Colorectal Adenomas in Adolescents

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BJ Hoskins et al.  J Gastroenterol Hepatol. 2026 Apr 24. Open Access! Incidental Colorectal Adenomas in Adolescents: Clinical Management, Genetic Evaluation, and Surveillance (Review article)

Key points:

  • “Although most isolated colorectal adenomas identified in adolescents are ultimately sporadic, their rarity at this age justifies a lower threshold for genetic evaluation—without routine shortening of surveillance intervals in the absence of hereditary disease”
  • “Current guidelines recommend initiating upper gastrointestinal surveillance at age 20–25 years for FAP and attenuated FAP [17]. Notably, a meta-analysis reported that 42% of children with FAP who underwent EGD had duodenal adenomas…, supporting the biological rationale for upper gastrointestinal screening once a polyposis syndrome is identified”
  • Table 1 lists polyposis syndromes that can be associated with isolated adenomas in adolescents
  • “All visible adenomas should be completely removed when technically feasible'”

My take: This review provides useful guidance when identifying an adenomatous polyp in the pediatric age group.

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Disclaimer: This blog, gutsandgrowth, assumes no responsibility for any use or operation of any method, product, instruction, concept or idea contained in the material herein or for any injury or damage to persons or property (whether products liability, negligence or otherwise) resulting from such use or operation. These blog posts are for educational purposes only. Specific dosing of medications (along with potential adverse effects) should be confirmed by prescribing physician.  Because of rapid advances in the medical sciences, the gutsandgrowth blog cautions that independent verification should be made of diagnosis and drug dosages. The reader is solely responsible for the conduct of any suggested test or procedure.  This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition

How Helpful is FLIP for Pyloric Dysfunction?

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A Porto et al. JPGN Reports. 2026;7:59–63. Open Access! Feasibility and clinical value of pyloric functional luminal imaging probe in an infant

Case report: “This case highlights the feasibility, safety, and clinical effectiveness of FLIP as a diagnostic and treatment tool in an infant with pyloric dysfunction.”

In brief, the authors describe a former 26 week premature infant with gastric dysfunction with gastric output >100 mL/kg/day while on GJ feeds. “His history was notable for necrotizing enterocolitis with multiple intestinal perforations and bowel resections with resultant short bowel syndrome (97 cm small bowel, intact colon) and chronic respiratory failure requiring tracheostomy and mechanical ventilation.” After obtaining FLIP measurements, IPBI (intrapyloric botulinum toxin injection) was performed with 100 international units of botulinum toxin A. Esoflip dilatation was performed using a 20 mm balloon. This led to full tolerance of gastric bolus feeds. When symptoms recurred, repeat IPBI and dilatation were performed with resolution of symptoms.

 FLIP demonstrated high pyloric pressures up to 105 mmHg,
Max diameter 13.3 mm (arrow) at 45 mL balloon inflation 

My take: I am not an expert on FLIP; however, it does not appear to be needed in this situation. Many practitioners would recommend botox injection with or without dilatation in patients with this type of presentation without using FLIP. The authors acknowledge that there are a “lack of reference values for infants” which makes FLIP interpretation more subjective.

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Beneficial GI Effect of GLP-1 Receptor Agonists: Lower Risk of Peptic Ulcer Disease

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P Seika et al. Clin Gastroenterol Hepatol 2026; 24: 974-985. Glucagon-like Peptide-1 Receptor Agonists Are Associated With a Lower Risk of Peptic Ulcer Disease: A Nationwide Cohort Study

Background: “Emerging evidence suggests that GLP-1RAs may exhibit anti-inflammatory properties and could play a role in GI mucosal protection. Proposed mechanisms include the suppression of proinflammatory cytokines, attenuation of reactive oxygen species, and enhancement of mucosal defences, which may reduce susceptibility to PUD.”

Methods: This was a nationwide retrospective study of adults with T2DM (66,102 participants) using the “All of Us” National Institutes of Health database, including a sub-group analysis of adults who were newly initiated on GLP-1RAs or insulin as second-line therapy. 

Key findings:

  • After adjusting for possible confounders, GLP-1RAs were associated with significantly lower odds of PUD diagnosis (adjusted odds ratio 0.56; P < .001)
  • Our subgroup included a total of 3313 patients (1270 new GLP-1RA users; 2043 new insulin users). In this analysis, switching to a GLP-1RA as second-line therapy was associated with a significantly lower hazard of PUD compared with switching to insulin (adjusted hazard ratio [HR], 0.44; P < .001)

My take:

  1. GLP-1 RAs are a remarkable advance. However, we need still more long-term data. Many times in healthcare, new treatments often receive a lot of favorable studies/good press. Over time and with more scrutiny, more adverse effects become evident.
  2. Though these medications can cause a lot GI symptoms, it is helpful to know that they are associated with a lower risk of peptic ulcer disease.

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We Are Going to See More Measles Tragedies

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“One death is a tragedy; a million is a statistic.” This quote is often misattributed to Joseph Stalin but is likely derived from the German journalist and satirist Kurt Tucholsky. So much of the arguments for vaccines focus on the millions of lives that have been saved. Yet, it is the individual sad stories that are often much more powerful. I was thinking of this quote as I read a NY Times Commentary by Rebecca Archer (4/21/26): Measles Took My Daughter. This Is What I Want Everyone to Know.

An excerpt:

When my daughter Renae, my firstborn, was 5 months old she spiked a fever…At the hospital the doctors noted the red spots on her body and diagnosed her with measles.

This was 2013, and Manchester, England, where we lived, was experiencing a measles outbreak that resulted in more than 1,000 suspected cases. A 1998 study by a British doctor, Andrew Wakefield, linking the measles, mumps and rubella vaccine to autism had caused vaccination rates to plummet. The study was later retracted and Mr. Wakefield stripped of his medical license, but the damage had been done. In 2013, most of the cases were among school-age children whose parents had refused to give them the vaccine, which is not compulsory in Britain, or among babies too young to be vaccinated, like my daughter…

Within a week she seemed back to normal. What I didn’t know was that measles can cause long-term complications. A child can seem fine while the virus slowly replicates in her brain, poised to exact a terrible toll years later…

Toward the end of the summer [2023], … she had also started moving very slowly, almost robotically, and often seemed confused. We took her back to the hospital, where another M.R.I. showed the swelling in her brain had become much worse… Renae had subacute sclerosing panencephalitis, a rare complication of measles. The doctors told me it was fatal, and there was nothing else they could do…

Last year, the United States saw its highest rate of measles cases in more than three decades and the country may soon lose its measles elimination status as well. Despite this, Health Secretary Robert F. Kennedy Jr. said he doesn’t think the government should be mandating vaccines, and that they should be a matter of personal choice.

Parents must realize that refusing vaccinations doesn’t just put your own child at risk. It puts other children at risk. 

Related articles:

  • LA Bacheschi, et al. NEJM 2026; 394: 1662. Measles 2025. Subacute sclerosing panencephalitis “was not rare before vaccination, as shown by an account of 82 cases… in Brazil from 1961 to 1983.”
  • DN Durrheim, JK Andrus. NEJM 2026; 394: 1662-1663. Measles 2025. The “measles still kills more than 100,000 children worldwide each year.”

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