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Caroline Apovian, former co-director of the Center for Weight Management and Wellness at Brigham and Women's Hospital, has noted: "GLP-1 agonists slow gastric motility, which can paradoxically worsen reflux symptoms in some patients during the titration period, even though the ultimate weight loss tends to improve GERD long-term." A practical monitoring framework for patients on both medications: Weeks 1 to 4 (semaglutide 0.25 mg): Baseline GI symptom assessment

Apply gentle pressure with a cotton ball if bleeding occurs, but do not massage the injection site as this can affect medication absorption