Glucagon-Like Peptide-1 Receptor Agonist Therapy Does Not Increase Gastrointestinal Adverse Events in Patients with Inflammatory Bowel Disease.

BACKGROUND: As the prevalence of obesity rises among patients with inflammatory bowel disease (IBD), concerns have emerged regarding the gastrointestinal safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are increasingly used for diabetes and weight management. METHODS: We conducted a retrospective cohort study of adult patients with IBD on GLP-1 RA therapy within a large academic medical system between 2010 and 2024. We compared gastrointestinal adverse events-including ileus or bowel obstruction, bowel surgery, IBD-related hospitalization, and escalation of medical therapy-occurring in the one-year period preceding and following GLP-1 RA exposure, which was defined by at least two prescriptions within 90 days. RESULTS: Among 271 patients (median age 62.8 years; 62% female; 64% ulcerative colitis), 80 completed 12 months and an additional 168 completed 6 months of GLP-1 RA therapy. Semaglutide was the most common agent (58%), followed by dulaglutide (28%), tirzepatide (14%), and liraglutide (1%). No significant difference in gastrointestinal adverse event rates was observed between pre- and post-treatment intervals when normalized for exposure time (p ≥ 0.10 for all comparable adverse events). Median BMI declined modestly from 33.8 to 33.4 kg/m at 12 months (p = 0.20). Subgroup analyses by agent, sex, IBD type, and GLP-1 RA indication yielded similar findings. CONCLUSIONS: GLP-1 RA therapy does not increase gastrointestinal adverse events in patients with IBD over 12 months, supporting its safety in this population.