{
 "page": "https://jabbitapp.com/research/ozempic-zepbound-gastroparesis-pancreatitis-bowel-obstruction-risk-teardown.html",
 "checked": "2026-10-28",
 "note": "Quotes asserted against cached copies. Chart 1: Sodhi et al. JAMA 2023 Table 1 (incidence per 1000 person-years, event counts in brackets: semaglutide, liraglutide, bupropion-naltrexone). Chart 2: hazard/odds ratios with 95% CIs as reported in each abstract; different designs, comparators and populations, not pooled. The Shanghai study is a preprint and not peer-reviewed. JPML counts are pending civil actions (allegations), not findings.",
 "pubmed_abstract_quotes": {
  "42851139": [
   "Gallbladder and biliary disease has the most consistent evidence supporting a causal association.",
   "For thyroid cancer, NAION, suicidal behaviour and self-harm, acute pancreatitis and intestinal obstruction, evidence regarding causality remains uncertain.",
   "Because these events are rare, even substantial relative risk increases generally correspond to small absolute risk increases in broad populations but may become relevant in patients with high baseline risk."
  ],
  "42894471": [
   "Among 78,277 patients, 87% reported no baseline GI symptoms.",
   "At 60 months, 53% reported at least one GISE, most commonly abdominal pain (28%) and nausea (25%).",
   "Women were at higher risk of GISE than men (Kaplan-Meier HR 1.4).",
   "Among 696 symptomatic patients clinically referred for GES after GLP-1RA initiation, 34.6% (N = 241) exhibited delayed GE.",
   "Among the small, symptom-selected subgroup referred for testing, only a third had delayed GE."
  ],
  "42418075": [
   "After matching, 164,987 patients were included in each cohort.",
   "de-novo gastroparesis being 13%, 8.7%, and 0.7% respectively",
   "gastroparesis (HR 1.57 [1.43, 1.73]), drug-induced pancreatitis (HR 2.85 [1.82, 4.48]) and a decreased risk of bowel obstruction (HR 0.86 [0.80, 0.92])",
   "but emergency room (ER) visits (HR 0.96 [0.95, 0.98]) and hospital admissions (HR 0.92 [0.91, 0.94]) were lower in the GLP-1 cohort"
  ],
  "42244136": [
   "Among 313 342 matched pairs of GLP-1 based therapies and SGLT-2i initiators",
   "followed on treatment for a median of 5.2 months",
   "incidence rates of the composite outcome were 1.02 among GLP-1 based therapies versus 0.75 among SGLT-2i initiators per 100 person-years",
   "(rate difference 0.27 per 100 person-years; HR 1.37, 95% CI 1.30, 1.45) for the composite event and each individual component",
   "The absolute risk of motility-related gastrointestinal adverse events was 1% or less but was higher among initiators of GLP-1 based therapies compared to SGLT-2i."
  ],
  "42684335": [
   "The weighted 30-day absolute risk of motility-related GI events was 0.51% for oxycodone, 0.35% for hydrocodone, and 0.33% for tramadol.",
   "We did not observe differences in the risk of gastroparesis."
  ],
  "40499738": [
   "We included 55 randomized controlled trials involving 106,395 participants.",
   "GLP-1RAs increased the risk of cholelithiasis (risk ratio [RR], 1.46; 95% CI, 1.09-1.97; 2 more cases per 1000)",
   "probably increased the risk of GERD (RR, 2.19; 95% CI, 1.48-3.25; 4 more cases per 1000)",
   "GLP-1RAs probably have little or no effect on the risk of other gastrointestinal or biliary events."
  ],
  "42600634": [
   "This meta-analysis included 52 studies.",
   "pancreatitis (odds ratio=1.29; 95% confidence interval: 0.91-1.84; p>0.05)"
  ],
  "39964295": [
   "The use of GLP-1 RA did not show an incremental risk of bowel obstruction or ileus compared to controls (OR 1.95, 95% CI 0.43-8.79). However, the studies had high heterogeneity (I2 = 94%).",
   "liraglutide was associated with a significantly high risk of bowel obstruction or ileus (OR 3.0, 95% CI 2.03-4.45; I2 = 0%)"
  ],
  "41596262": [
   "Fifty RCTs (47 publications; 192,359 participants) met inclusion criteria.",
   "liraglutide was associated with a lower risk of intestinal obstruction (OR 0.44, 95% CI 0.24-0.81)",
   "No other GLP-1 receptor agonist or SGLT2 inhibitor demonstrated a statistically significant increase in obstruction risk."
  ],
  "38634551": [
   "with a pooled mean difference of 36.0 minutes (95% CI 17.0-55.0, P < 0.01, I2 = 79.4%)",
   "Ten studies (n = 411) utilized the acetaminophen absorption test, with no significant delay in gastric emptying"
  ],
  "35344001": [
   "A total of 76 RCTs involving 103 371 patients",
   "increased risks of gallbladder or biliary diseases (RR, 1.37; 95% CI, 1.23-1.52)",
   "in trials for weight loss (n = 13; RR, 2.29; 95% CI, 1.64-3.18)"
  ]
 },
 "sodhi_jama_2023_quotes": [
  "We used a random sample of 16 million patients (2006-2020) from the PharMetrics Plus database (IQVIA)",
  "Our cohort included 4144 liraglutide, 613 semaglutide, and 654 bupropion-naltrexone users.",
  "Pancreatitis 4.6 (2) 7.9 (71) 1.0 (1) Bowel obstruction 0 8.1 (73) 1.7 (2) Gastroparesis 9.1 (4) 7.3 (66) 3.1 (3)",
  "increased risk of pancreatitis (adjusted HR, 9.09 [95% CI, 1.25-66.00]), bowel obstruction (HR, 4.22 [95% CI, 1.02-17.40]), and gastroparesis (HR, 3.67 [95% CI, 1.15-11.90) but not biliary disease (HR, 1.50 [95% CI, 0.89-2.53])",
  "Male 55.8 61.0 82.4",
  "Limitations include that although all GLP-1 agonist users had a record for obesity without diabetes, whether GLP-1 agonists were all used for weight loss is uncertain.",
  "Conflict of Interest Disclosures: None reported."
 ],
 "preprint_rs_11029518_quotes": [
  "This is a preprint; it has not been peer reviewed by a journal",
  "After 1:10 propensity score matching, 29,216 patients were included, comprising 2,656 GLP-1RA initiators and 26,560 DPP-4i initiators.",
  "(hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.08 to 1.61; P=0.006)",
  "Gastroparesis showed the strongest signal (HR 1.99, 95% CI 1.40 to 2.81; P<0.001).",
  "pancreatitis (HR 1.31, 95% CI 0.74 to 2.34), and intestinal obstruction (HR 1.02, 95% CI 0.60 to 1.74) were not significantly elevated"
 ],
 "wegovy_label_2026_06_quotes": [
  "Revised: 06/2026",
  "acute pancreatitis was confirmed by adjudication in 4 WEGOVY-treated patients (0.2 cases per 100 patient years) and 1 in placebo-treated patients (less than 0.1 cases per 100 patient years)",
  "Severe gastrointestinal adverse reactions were reported in 4.1% and 0.9% of WEGOVY injection and placebo-treated patients, respectively",
  "WEGOVY is not recommended in patients with severe gastroparesis.",
  "ileus, intestinal obstruction, severe constipation including fecal impaction",
  "cholelithiasis was reported by 1.6% of WEGOVY injection-treated patients and 0.7% of placebo-treated patients",
  "which may include persistent or severe abdominal pain (sometimes radiating to the back), and which may or may not be accompanied by nausea or vomiting",
  "There have been rare postmarketing reports of pulmonary aspiration in patients receiving GLP-1 receptor agonists undergoing elective surgeries or",
  "it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure"
 ],
 "ozempic_injection_label": {
  "set_id": "adec4fd2-6858-4c99-91d4-531f5f2a2d79",
  "quotes": [
   "acute pancreatitis was confirmed by adjudication in 7 OZEMPIC-treated patients (0.3 cases per 100 patient years) versus 3 in comparator-treated patients (0.2 cases per 100 patient years)",
   "severe gastrointestinal adverse reactions were reported more frequently among patients receiving OZEMPIC (0.5 mg 0.4%, 1 mg 0.8%) than placebo (0%)",
   "OZEMPIC is not recommended in patients with severe gastroparesis.",
   "ileus, intestinal obstruction, severe constipation including fecal impaction"
  ]
 },
 "zepbound_label": {
  "set_id": "487cd7e7-434c-4925-99fa-aa80b1cc776b",
  "effective": "20260828",
  "quotes": [
   "0.2% of ZEPBOUND-treated patients had acute pancreatitis confirmed by adjudication (0.14 patients per 100 years of exposure) versus 0.2% of placebo-treated patients (0.15 patients per 100 years of exposure)",
   "severe gastrointestinal adverse reactions were reported more frequently among patients receiving ZEPBOUND (5 mg 1.7%, 10 mg 2.5%, 15 mg 3.1%) than placebo (1%)",
   "ZEPBOUND is not recommended in patients with severe gastroparesis.",
   "ileus, intestinal obstruction, severe constipation including fecal impaction"
  ]
 },
 "jpml_2026_10_01_quotes": [
  "Report Date: 10/1/2026",
  "MDL -3094 IN RE: Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs) Products Liability Litigation 4,025 4,139"
 ],
 "chart_data": {
  "sodhi_per_1000py": [
   [
    "Pancreatitis",
    [
     4.6,
     2
    ],
    [
     7.9,
     71
    ],
    [
     1.0,
     1
    ]
   ],
   [
    "Bowel obstruction",
    [
     0,
     0
    ],
    [
     8.1,
     73
    ],
    [
     1.7,
     2
    ]
   ],
   [
    "Gastroparesis",
    [
     9.1,
     4
    ],
    [
     7.3,
     66
    ],
    [
     3.1,
     3
    ]
   ]
  ],
  "forest": [
   [
    "Pancreatitis",
    "JAMA 2023 letter (vs bupropion-naltrexone)",
    9.09,
    1.25,
    66.0
   ],
   [
    "Pancreatitis",
    "Dig Dis Sci 2026 (TriNetX, vs no GLP-1)",
    2.85,
    1.82,
    4.48
   ],
   [
    "Pancreatitis",
    "Shanghai preprint 2026 (vs DPP-4i)",
    1.31,
    0.74,
    2.34
   ],
   [
    "Pancreatitis",
    "Meta-analysis, 52 obesity studies (2026)",
    1.29,
    0.91,
    1.84
   ],
   [
    "Bowel obstruction",
    "JAMA 2023 letter (vs bupropion-naltrexone)",
    4.22,
    1.02,
    17.4
   ],
   [
    "Bowel obstruction",
    "Meta-analysis, 6 studies (2026)",
    1.95,
    0.43,
    8.79
   ],
   [
    "Bowel obstruction",
    "Shanghai preprint 2026 (vs DPP-4i)",
    1.02,
    0.6,
    1.74
   ],
   [
    "Bowel obstruction",
    "Dig Dis Sci 2026 (TriNetX, vs no GLP-1)",
    0.86,
    0.8,
    0.92
   ],
   [
    "Gastroparesis",
    "JAMA 2023 letter (vs bupropion-naltrexone)",
    3.67,
    1.15,
    11.9
   ],
   [
    "Gastroparesis",
    "Shanghai preprint 2026 (vs DPP-4i)",
    1.99,
    1.4,
    2.81
   ],
   [
    "Gastroparesis",
    "Dig Dis Sci 2026 (TriNetX, vs no GLP-1)",
    1.57,
    1.43,
    1.73
   ]
  ]
 }
}