https://doi.org/10.4081/ecj.2026.14970
Acute ischaemic colitis after initiation of tirzepatide in an elderly patient with type 2 diabetes
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Published: 27 April 2026
Tirzepatide, a dual GLP-1/GIP receptor agonist, is increasingly used for the treatment of type 2 diabetes and obesity. While gastrointestinal side effects such as nausea and diarrhoea are common, reports of ischemic colitis potentially associated with tirzepatide are extremely rare. Understanding potential mechanisms is critical for early recognition and management. We report the case of a 77-year-old woman with type 2 diabetes, severe obesity, and cardiovascular comorbidities, who developed acute onset abdominal pain and rectal bleeding two days after her second dose of tirzepatide. On admission, laboratory evaluation showed leucocytosis and elevated C-reactive protein. Abdominal CT demonstrated segmental left-sided colitis with diverticulosis. Rectosigmoidoscopy revealed hyperaemic, oedematous, friable mucosa with superficial ulcerations in the sigmoid colon. Histology was consistent with erosive colitis with features suggestive of ischemic injury. Infectious workup was negative. The patient was promptly started on intravenous metronidazole, fluid resuscitation, and pantoprazole. Clinical symptoms resolved over the subsequent days, and laboratory markers improved. This case highlights a potential association between tirzepatide therapy and ischemic colitis. Mechanisms may include delayed gastrointestinal motility, increased intraluminal pressure, relative hypovolemia, and possible neuroenteric microvascular modulation. Clinicians should be aware of this rare but serious complication, particularly in patients with cardiovascular comorbidities.
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CRediT authorship contribution
Conceptualization, Gianlugi Cuomo and Paolo Tirelli; methodology, Gianluigi Cuomo; validation, Antonio D’Antonio and Leonardo De Luca.; investigation, Antonietta De Sena; resources, Vittoria Gammaldi and. Valeria Ciliberti; data curation, Rossella D’Onofrio; writing—original draft preparation, Gianluigi Cuomo; writing—review and editing, Paolo Tirelli; visualization, Gianluigi Cuomo, Rossella D’Onofrio and Valeria Ciliberti; supervision, Vincenzo Nuzzo All authors have read and agreed to the published version of the manuscript.
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