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Dec 2017;50(18):1275-1280

Eur J Nucl Med Mol Imaging 2012

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Alarm features include: Age 50 or older (especially if symptoms are new) Difficulty or pain when swallowing Vomiting blood, passing black stools, or any GI bleeding Unexplained weight loss Iron deficiency (with or without anaemia) A palpable abdominal mass Severe or persistent abdominal pain Regular use of ulcer-causing meds like NSAIDs (e.g., ibuprofen, diclofenac) Strong family history of upper GI cancer or relevant genetic syndromes If youre under 50 with no red flags: the usual starting approach When someone is under 50 , has no alarm features , and no concerning medical history, management often starts with a low-risk pathway

Orlistat causes different side effects related to its mechanism of reducing fat absorption: Oily spotting and flatulence Urgent bowel movements and faecal incontinence Oily or fatty stools These effects are typically worse when consuming high-fat meals and can be socially distressing

The possibility that GLP-1 receptor agonists may be effective for some substance use disorders is promising, but we need large randomized controlled trials to confirm benefit and clarify for whom they work best, he says