Introduction: multiorgan system benefits of GLP-1 receptor agonists

Recently, there have been several important contributions published in GUT on the role of glycaemic control and glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) in diverse gastrointestinal diseases. First, there was a reduction of 10-year risk of major adverse liver outcomes (MALO), that is, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation or MALO-related death, based on Swedish healthcare registers (2010–2020). The study compared GLP-1 RA initiators to non-initiators among patients with chronic liver disease and type 2 diabetes (T2D).1 The best benefit was observed for those documented to have continued GLP-1 RAs, but it was not significant for GLP-1 RA initiators without continued use. A published commentary discussed the complexity of the study design and analysis and questioned the real-world applicability of the data.2

Second, the potential benefit of a holistic approach to the treatment of metabolic dysfunction-associated steatotic liver disease in obese young people has been proposed3 given the demonstration that non-alcoholic fatty liver disease increases the risk of T2D, malignancy and other cardiometabolic disorders including incident major adverse cardiovascular events.4–6

Third, the beneficial effects of optimised glycaemic control (a main indication for GLP-1 RAs in T2D and obesity with pre-diabetes) were highlighted by Adolph et al7 through discussion of the important roles of lifestyle, diet and related gut microbial perturbations in the aetiology of inflammatory bowel disease (IBD) as well as metabolic disorders. The detrimental effects of lifestyle and diet were based on three types of studies: …