Ozempic (semaglutide) is a once-weekly injectable medication licensed in the UK for managing type 2 diabetes mellitus. As a GLP-1 receptor agonist, it works by regulating blood sugar levels, slowing gastric emptying, and reducing appetite. Whilst effective for glycaemic control, some patients wonder: does Ozempic make GORD worse? Gastro-oesophageal reflux disease (GORD) causes stomach acid to flow back into the oesophagus, leading to heartburn and discomfort. Understanding the relationship between Ozempic and reflux symptoms is important for patients and clinicians managing diabetes alongside digestive health concerns.

What Is Ozempic and How Does It Work?

Ozempic (semaglutide) is a prescription medicine licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that helps regulate blood sugar levels.

The medication is administered as a once-weekly subcutaneous injection, typically into the abdomen, thigh, or upper arm. Treatment usually starts with 0.25 mg once weekly for 4 weeks, then increases to 0.5 mg weekly, with possible further increases to 1 mg or 2 mg if needed for glycaemic control. Ozempic works through several mechanisms:

• Stimulates glucose-dependent insulin secretion from the pancreas in response to elevated blood glucose levels

• Suppresses glucagon release, reducing the amount of glucose produced by the liver

• Slows gastric emptying, which means food moves more slowly from the stomach into the small intestine

• Reduces appetite through effects on brain centres that regulate hunger

The slowing of gastric emptying is particularly relevant when considering gastrointestinal side effects. By keeping food in the stomach for longer periods, Ozempic helps prevent rapid spikes in blood sugar after meals. However, this same mechanism can contribute to digestive symptoms in some patients, particularly during dose escalation.

Ozempic is prescribed alongside diet and exercise modifications and is often used when other diabetes medications have not provided adequate blood sugar control. The Medicines and Healthcare products Regulatory Agency (MHRA) has approved its use in the UK, and NICE guideline NG28 supports its use in specific clinical circumstances for adults with type 2 diabetes. Ozempic is not indicated for type 1 diabetes or diabetic ketoacidosis, and caution is advised in patients with severe gastrointestinal disease. Whilst Ozempic has gained attention for weight loss effects, its primary licensed indication remains diabetes management.

Can Ozempic Make GORD Worse?

Gastro-oesophageal reflux disease (GORD) occurs when stomach acid frequently flows back into the oesophagus, causing symptoms such as heartburn, regurgitation, and chest discomfort. The question of whether Ozempic can worsen GORD is clinically relevant, given the medication's effects on the digestive system.

While the UK Summary of Product Characteristics (SmPC) does not specifically list GORD as a common adverse reaction, gastrointestinal effects are well-documented with semaglutide. The delayed gastric emptying mechanism may theoretically contribute to reflux symptoms in susceptible individuals. When the stomach empties more slowly, food and gastric contents remain in the stomach for extended periods, potentially increasing pressure and the likelihood of reflux into the oesophagus.

Clinical trial data and post-marketing surveillance have identified gastrointestinal adverse effects as among the most common with GLP-1 receptor agonists:

• Nausea (very common, affecting ≥1/10 patients)

• Vomiting (common, affecting ≥1/100 to <1/10 patients)

• Diarrhoea (very common)

• Abdominal pain (common)

• Constipation (common)

• Dyspepsia/indigestion (common)

These effects are typically most pronounced during dose escalation and often improve with continued treatment. Some patients do report worsening reflux symptoms when taking Ozempic. This may be more pronounced in individuals with pre-existing GORD or those with other risk factors for reflux, such as obesity, hiatus hernia, or certain dietary habits.

It is important to note that correlation does not equal causation. Many patients prescribed Ozempic have type 2 diabetes and obesity—both conditions independently associated with increased GORD risk. Therefore, distinguishing whether Ozempic directly worsens reflux or whether symptoms arise from underlying conditions can be challenging. If you experience new or worsening reflux symptoms after starting Ozempic, this warrants discussion with your GP or diabetes specialist.

If you suspect you are experiencing side effects from Ozempic, you can report these through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk).

Managing GORD While Taking Ozempic

If you are taking Ozempic and experiencing GORD symptoms, several evidence-based strategies can help manage reflux whilst continuing your diabetes treatment. These approaches align with NICE guidance (CG184) on GORD management and focus on both lifestyle modifications and appropriate medical therapy.

Lifestyle and dietary modifications form the foundation of GORD management:

• Eat smaller, more frequent meals rather than large portions, which can reduce gastric pressure

• Avoid eating within 3 hours of bedtime to allow time for gastric emptying before lying down

• Identify and limit trigger foods, commonly including fatty foods, chocolate, caffeine, alcohol, spicy foods, and acidic items like citrus and tomatoes

• Maintain a healthy weight, as excess weight increases abdominal pressure and reflux risk

• Elevate the head of your bed by 15–20 cm using blocks or a wedge pillow

• Avoid tight-fitting clothing around the abdomen

• Stop smoking, as tobacco weakens the lower oesophageal sphincter

• Review medications that may worsen reflux (e.g., NSAIDs, some calcium channel blockers) with your GP or pharmacist

Pharmacological management may be necessary for symptom control. Your GP may recommend:

• Antacids for occasional, mild symptoms (available over the counter)

• Alginate preparations (e.g., Gaviscon) that form a protective raft on top of stomach contents

• Proton pump inhibitors (PPIs) such as omeprazole or lansoprazole for more persistent symptoms—these are the most effective medications for GORD and work by reducing stomach acid production. Once symptoms are controlled, the lowest effective dose should be used

• H2 receptor antagonists like famotidine or cimetidine as a second-line option

It is essential to take Ozempic as prescribed and not discontinue it without medical advice, as maintaining good glycaemic control is crucial for your overall health. If gastrointestinal symptoms are troublesome, your doctor may slow the dose titration or maintain you on a lower dose of Ozempic. Many patients find that GORD symptoms improve as their body adjusts to Ozempic over the first few weeks of treatment. Stay well-hydrated, especially if experiencing vomiting or diarrhoea.

When to Speak to Your GP About Ozempic and GORD

Whilst mild, transient digestive symptoms are common when starting Ozempic, certain situations require prompt medical attention. Knowing when to contact your GP or seek urgent care is essential for patient safety.

You should arrange a routine GP appointment if:

• Reflux symptoms are new or significantly worse since starting Ozempic

• Over-the-counter remedies and lifestyle changes have not improved symptoms after 2–3 weeks

• You experience persistent nausea or vomiting that affects your ability to eat or take medications

• GORD symptoms are interfering with your quality of life, sleep, or daily activities

• You require regular use of antacids (more than twice weekly) for symptom relief

• You have concerns about continuing Ozempic due to side effects

Your GP can assess whether dose adjustment, additional medications for reflux, or alternative diabetes treatments might be appropriate. They may also investigate whether other factors are contributing to your symptoms.

Seek urgent medical attention (contact your GP urgently, call NHS 111, or attend A&E) if you experience:

• Difficulty or pain when swallowing (dysphagia or odynophagia)

• Persistent vomiting, particularly if you cannot keep down fluids

• Vomiting blood or material that looks like coffee grounds

• Black, tarry stools (melaena) or blood in stools, which may indicate gastrointestinal bleeding

• Severe, persistent abdominal pain, especially if radiating to the back (which could indicate pancreatitis—stop taking Ozempic immediately)

• Unexplained weight loss (particularly if you are aged 55 or over)

• Symptoms of dehydration, including dizziness, reduced urination, or extreme thirst

If you experience severe chest pain, call 999 immediately as this could indicate a cardiac problem rather than GORD.

These red flag symptoms may indicate complications such as oesophagitis, gastric ulceration, pancreatitis, or potentially serious conditions requiring immediate investigation. NICE guidelines recommend urgent specialist referral (within two weeks) for certain symptoms, particularly in adults aged 55 and over with dysphagia or those with unexplained weight loss and upper abdominal symptoms. Never hesitate to seek medical advice if you are concerned about your symptoms—early intervention can prevent complications and ensure your treatment plan remains safe and effective.

Frequently Asked Questions