A woman had to remove a foot of her colon after taking Ozempic
Key Takeaways
Industry Buzz
"I had no warning that this was even a possibility.” — Juanita Gantt, patient, CBS News
“GLP-1 receptor agonists are powerful tools, but they’re not for everyone. I think there’s so much excitement around their weight loss and diabetes benefits that we sometimes downplay the risks. [...] Patients are often so thrilled with the weight loss they might not mention side effects unless you ask directly.” — Harsh Sheth, MBBS, MS
Find more of your peers' perspectives and insights below.
In October 2023, Juanita Gantt, a 62-year-old woman from Pennsylvania, was rushed to the hospital after collapsing at home. What followed was a medical crisis that allegedly led to the removal of at least a foot of her colon and left her dependent on an ileostomy bag.[]
Gantt had been prescribed Wegovy and Ozempic—both semaglutide-based drugs—to help manage her weight and the risk of acquiring diabetes. Now, she’s suing Novo Nordisk, the drugs’ manufacturer, alleging that she wasn’t adequately warned about their potential to cause such severe gastrointestinal complications.
Are you familiar with this potential side effect?
Semaglutide, like other GLP-1 receptor agonists, works by slowing gastric emptying and suppressing appetite. While these mechanisms contribute to its efficacy in weight management and glycemic control, they can also affect the neuromuscular contraction in the GI tract.
Adverse effects such as nausea, vomiting, bloating, and constipation are well-documented. Still, the potential for severe complications like gastroparesis and food-induced small bowel obstruction (FIBO) is increasingly coming to light. In serious cases, there are also reports of obstruction severe enough to require laparoscopic surgery.[]
Related: 5 unexpected side effects of Ozempic useAs of June 2023, the FDA had published 8,571 gastrointestinal adverse event reports for semaglutide, 33 of which involved ileus; two cases were allegedly fatal.[] This prompted updates to Ozempic's labeling, specifically, a black box warning, to reflect the risk of such severe outcomes.
Gap in pharmacovigilence?
A 2023 report published in Acta Pharmaceutica Sinica suggested that GLP-1 agonists could induce structural changes in the gut.[]
Experimental animal models revealed a 43% increase in intestinal length, along with fibrosis-like characteristics, potentially leading to a "loose spring" effect in the small bowel, predisposing patients to chronic pseudo-obstruction.
Bariatric surgeon Harsh Sheth, MBBS, MS, states, “There’s a gap regarding long-term data for people with underlying GI conditions. GLP-1s are revolutionary, but we don’t have enough large-scale studies on how they affect high-risk patients over the years. Another issue is mild complications being underreported—things like intermittent ileus or moderate constipation aren’t always flagged, but they matter.”
Some of the data we do have indicates the following:
Patients using incretin-based drugs like GLP-1 agonists are 4.5 times more likely to experience intestinal obstruction compared to those on other anti-diabetics.[]
A real-world disproportionality analysis of FDA pharmacovigilance data (2018-2023) revealed new adverse reaction signals for semaglutide related to intestinal obstruction.[] The authors wrote that “in severe cases, the intestinal blood supply may be compromised leading to the death of intestinal tissue, which can threaten the patient's life.”
However, according to Manhattan Gastroenterology’s Qin Rao, MD, no current studies have reported a risk of such intestinal perforation: “I have not encountered any cases of intestinal perforation or other surgical complications associated with GLP1 agonists,” he tells MDLinx. "[But] there is a low risk of intestinal obstruction, which in theory is a risk for ischemia and perforation.”
@keepgoingkat Ozempic lawsuits are being filed because the company failed to warn users of serious health conditions associated with Ozempic, including gastroparesis, ileus, intestinal blockage and gallbladder diseases.
♬ original sound - Kat Maisano | Fitness Recipes
Predisposing factors and mitigating risk
While gastrointestinal perforation linked to GLP-1 receptor agonists is not well-documented, it’s clear these medications demand caution in high-risk patient populations. Dr. Rao says, “The risk of obstruction is increased in patients who have prior GI surgeries, a history of chronic constipation, inflammatory bowel disease, diverticulosis, or a history of chronic opioid use. These patients should use GLP1 agonists cautiously since intestinal obstruction increases the risk of perforation.”
He adds, “A doctor should discuss these risks with the patient before starting these medications. A patient might consider starting a laxative or trying to reduce certain medications that can interact with GLP-1 agonists prior to starting them. They should be monitored closely, especially when the dose of the medication is increased.”
Communication and shared decision-making is also of the utmost importance, Dr. Sheth says. “One thing I’ve noticed is that patients are often so thrilled with the weight loss they might not mention side effects unless you ask directly.”
He points out that, while GLP-1s are “powerful tools,” they may not be for everyone: “I think there’s so much excitement around their weight loss and diabetes benefits that we sometimes downplay the risks, especially for people with predisposing factors,” says Dr. Sheth.
What this means for you
Clinicians should educate patients on semaglutide to recognize red flags for gastrointestinal adverse effects early. Persistent bloating, severe abdominal pain, or prolonged constipation are all signs that warrant immediate investigation, such as the case of Juanita Gantt, whose Ozempic use necessitated surgical removal of more than a foot of her colon.