BackgroundGlucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used for the treatment of type 2 diabetes mellitus and obesity. Although gastrointestinal adverse effects are common, gastroparesis is an under-recognised but clinically important complication. This systematic review summarises published evidence on the presentation, diagnosis, management, and outcomes of gastroparesis associated with GLP-1RA therapy in real-world clinical practice.MethodsA systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, Scopus, and Web of Science were searched from inception to October 2025 for reports of symptomatic gastroparesis associated with GLP-1RA use. Eligible studies included case reports, case series, observational studies, and clinical trials involving adults treated with GLP-1RAs for diabetes or weight loss. Data extraction focused on patient characteristics, GLP-1RA exposure, clinical presentation, diagnostic findings, management strategies, and outcomes. Methodological quality was assessed using the Joanna Briggs Institute checklist for case reports.ResultsTwelve case reports describing 13 patients met inclusion criteria. Most patients were female and had type 2 diabetes mellitus, though cases also occurred in non-diabetic individuals. Semaglutide was the most frequently implicated agent, followed by liraglutide, dulaglutide, and exenatide. Symptom onset ranged from hours to several months after treatment initiation, commonly following dose escalation or inappropriate re-initiation. Presentations varied from acute to chronic. Reported symptoms included nausea, vomiting, abdominal pain, bloating, early satiety, and oral intolerance. Diagnostic evaluation often demonstrated gastric distension or retained gastric contents on imaging or endoscopy in the absence of mechanical obstruction. Gastric emptying scintigraphy confirms delayed emptying in selected cases. Management primarily involved supportive and symptomatic care. Discontinuation of the offending GLP-1RA led to symptom resolution in all reported patients.ConclusionGLP-1 receptor agonists may induce or worsen gastroparesis in both diabetic and non-diabetic patients, particularly following rapid dose escalation or inappropriate dosing. Awareness of this association is essential for timely diagnosis and management. Withdrawal of the causative agent is central to treatment and is associated with favourable outcomes and reversibility of gastric dysfunction. Careful patient selection, gradual dose titration, and monitoring for persistent gastrointestinal symptoms are recommended to optimise the safe use of GLP-1RAs.
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