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The effects of delayed gastric emptying may further compound the risk factors harbored by the obese, diabetic patient: Gastroparesis secondary to diabetes-related autonomic dysfunction Bowel dysmotility from opioids (chronic pain) and prolonged bed-rest Altered oesophageal-gastric anatomy from bariatric surgery Gastric insufflation from overzealous bag-valve ventilation with high PEEP and difficult airway Reduced efficacy of routine antiemetic regime Nausea and vomiting are reported by approximately 50% of patients using GLP-1 agonists, as direct results of reduced gastric motility and activation of central satiety centers

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Inhibition of GPR109A can be accomplished through the Gln metabolism/ER stress/GPR109A axis

98% Absorption: Delivers active nutrients directly to the dermis, bypassing surface barriers for higher efficiency

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