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This subset has distinct characteristics: Clinical pattern: Constipation begins in the first 4-8 weeks (typical) Symptoms plateau but don't improve after 12-16 weeks at stable dose Requires ongoing daily laxative use (usually polyethylene glycol) Worsens with dose escalation and improves with dose reduction Resolves within 2-4 weeks of discontinuing medication Why this happens: The current hypothesis is inadequate compensatory upregulation of non-GLP-1 motility pathways

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Ivanov, T

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