The role of glucagon-like peptide 1 receptor agonists in the management of patients with inflammatory bowel diseases

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Abstract
Obesity is increasingly prevalent among patients with inflammatory bowel diseases (IBD), with more than half of individuals with Crohns disease (CD) or ulcerative colitis (UC) classified as overweight or obese at diagnosis. Beyond body mass index (BMI), visceral adipose tissue (VAT) is emerging as a critical determinant of adverse IBD outcomes, including increased disease activity, reduced therapeutic response, higher surgical risk, and postoperative recurrence. Obesity and excess VAT also amplify cardiometabolic comorbidities commonly observed in IBD, such as metabolic dysfunction–associated steatotic liver disease (MASLD) and atherosclerotic cardiovascular disease (CVD), even in patients without traditional risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have transformed obesity management and confer established CVD and metabolic benefits. Preclinical studies show that GLP-1 RAs reduce visceral adiposity, modulate gut microbiota, enhance intestinal barrier integrity, and attenuate proinflammatory signaling pathways relevant to IBD pathogenesis. Emerging human data suggest that therapy with GLP-1 RAs is safe in patients with IBD and is associated with lower rates of hospitalization and surgical risk, particularly among patients with obesity, although effects on disease activity remain unclear. Several ongoing randomized controlled trials are evaluating GLP-1 RAs as adjunctive therapy for IBD. Beyond intestinal inflammation, GLP-1 RAs may favorably impact IBD-associated comorbidities, including MASLD, CVD, neurologic disorders, chronic pain, and metabolic bone disease. Important considerations include gastrointestinal tolerability, procedural implications for endoscopy, and the risk of lean muscle mass loss, underscoring the need for multidisciplinary care. As obesity becomes increasingly common in IBD, GLP-1 RAs represent a promising therapeutic strategy warranting further prospective investigation.

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