The Impact of GLP-1 Receptor Agonists on Ulcerative Colitis Patients – Following Restorative Ileal Pouch Anal Anastomosis

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for obesity and metabolic disease and may exert anti-inflammatory effects in inflammatory bowel disease. However, their effects on gastrointestinal motility may have distinct implications in patients with surgically altered intestinal anatomy. We evaluated the temporal relationship between recent GLP-1RA initiation and pouchitis in patients with a prior restorative ileal pouch–anal anastomosis (IPAA). Methods: We retrospectively reviewed patients with a history of total proctocolectomy and restorative IPAA who were admitted with pouchitis between January 2016 and January 2026 and had initiated GLP-1RA therapy within the preceding 6 weeks. Demographic characteristics, body mass index (BMI), and clinical features were descriptively evaluated. Results: Six patients met inclusion criteria, including three men and three women. The mean age was 37 years (range, 27–49 years), and the mean BMI was 40.2 kg/m². All patients had recently initiated GLP-1RA therapy before admission for pouchitis. The temporal association between GLP-1RA exposure and the development of pouch-related symptoms raises the possibility of an association between altered gastrointestinal transit and pouch inflammation. Discussion: Although GLP-1RAs may exert beneficial anti-inflammatory effects, pharmacologically mediated gastrointestinal hypomotility may have opposing consequences in patients with an ileal pouch. Altered transit, luminal stasis, and changes in the pouch microbial environment may contribute to mucosal inflammation. Further investigation is warranted to clarify the relationship between GLP-1RA therapy, intestinal motility, and pouchitis.