Efectos adversos gastrointestinales del agonista del receptor de GLP-1: revisión narrativa
DOI:
https://doi.org/10.52787/agl.v56i3.690Palabras clave:
Receptores del péptido similar al glucagón tipo 1, efectos adversos relacionados con los medicamentos, náuseas, gastroparesia, obesidad, diabetesResumen
Los agonistas del receptor del péptido similar al glucagón tipo 1 (GLP-1 RA) han transformado el manejo de la diabetes mellitus tipo 2 y la obesidad, con indicaciones en expansión que abarcan enfermedades cardiovasculares, renales y hepáticas. A medida que su uso se extiende a poblaciones diversas, los eventos adversos gastrointestinales (GIAE) se han convertido en la principal limitación de tolerabilidad y una causa frecuente de suspensión del tratamiento. Esta revisión sintetiza los mecanismos, el espectro clínico y el manejo de los GIAE asociados con los GLP-1 RA. Estos efectos resultan de mecanismos periféricos y centrales: la activación periférica de los receptores enlentece la motilidad gástrica, mientras que la activación en el área postrema y el núcleo del tracto solitario podría contribuir a las náuseas y los vómitos. Esta dualidad explica la escasa correlación entre la intensidad de los síntomas y el retraso medido del vaciamiento gástrico, así como el uso frecuente de antieméticos de acción central. En ensayos clínicos, las náuseas, vómitos, diarrea, estreñimiento y dolor abdominal muestran un gradiente dependiente de la dosis y la indicación, con mayor frecuencia a dosis altas empleadas para obesidad y esteatohepatitis asociada a disfunción metabólica (MASH), así como con agonistas múltiples. La mayoría de los síntomas son leves, aparecen durante el escalamiento y disminuyen con el tiempo; sin embargo, una minoría presenta síntomas persistentes y un subgrupo desarrolla gastroparesia. El manejo debe ser anticipatorio e incluir evaluación basal, educación y medidas dietéticas antes del tratamiento farmacológico. Las prioridades futuras incluyen estandarizar las mediciones de motilidad gastrointestinal, identificar biomarcadores predictivos y desarrollar algoritmos de manejo basados en evidencia.
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