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Contact your healthcare provider promptly if you experience: Severe or persistent heartburn unresponsive to over-the-counter antacids or lifestyle modifications Difficulty swallowing (dysphagia) or painful swallowing (odynophagia), which may indicate esophageal inflammation or stricture Persistent nausea and vomiting that prevents adequate oral intake or leads to dehydration Vomiting blood (hematemesis) or material resembling coffee grounds Black, tarry stools (melena) or visible blood in stool Severe abdominal pain, particularly if localized to the upper abdomen or radiating to the back (stop medication immediately if pancreatitis is suspected) Right upper quadrant pain, fever, or yellowing of skin/eyes, which may indicate gallbladder disease Unintentional weight loss beyond expected therapeutic effects New or worsening chest pain (call 911 if concerning for heart attack), especially if accompanied by shortness of breath These symptoms may indicate complications such as erosive esophagitis, gastrointestinal bleeding, pancreatitis, or gastroparesis

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Glucagon-Like Peptide-1 Receptor Agonists in Post-bariatric Surgery Patients: A Systematic Review and Meta-analysis

The results of a transcriptomic analysis obtained from a mouse model also revealed that the stimulation of GLP-1 receptor by high doses of exendin-4 upregulates IGF-1R typically in pancreatic islets, thus reinforcing the concept that activating the IGF-1R/IRS-2/Akt pathway mediates the prevention of -cell loss under the control of incretins (40)

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