S3824 From Weight Loss to Gut Loss: Semaglutide-Induced Ischemic Colitis

Introduction: With the recent rise in popularity of weight loss medications including glucagon-like-peptide-1 receptor agonists (GLP-1 RA) such as semaglutide, there is an increasing demand for such medications and an increasing need to understand long term medication side effects. Majority of patients experience mild to moderate gastrointestinal symptoms including abdominal pain, constipation, diarrhea, nausea, and vomiting. In this case presentation, we present a rare finding of ischemic colitis induced by semaglutide in an otherwise healthy patient. Case Description/Methods: A 45-year-old woman with no significant past medical history presented with vomiting, lower abdominal cramping, and diarrhea. She started semaglutide approximately 5 months prior to this episode. Initial workup were notable for leukocytosis of 17,100 cells/μL and a C-reactive protein of 28 mg/dL. Imaging results showed inflammatory changes around the sigmoid colon and nonspecific colitis. After 2 days of supportive care and failed medical management with antibiotics, the patient undergoes a flexible sigmoidoscopy which showed a diffuse area of ischemic-appearing colon. Hematology was consulted and workup was insignificant for hypercoagulable origins. The patient undergoes an uneventful hemicolectomy and has since recovered well. Discussion: The long-term side effects of GLP-1 agonists continue to remain uncertain and poses a challenge due to increasing demand for these medications. Ischemic colitis continues to remain a rare side effect, though there appears to be several reported incidents in case reports. In more recent discussions, the U.S. Food and Drug Administration has also been evaluating GLP-1 agonists for potential suicidal thoughts or actions, though evidence appears limited currently. Further investigation into the long-term side effects of GLP-1 agonists for weight loss is recommended.