Ischemic colitis associated with oral semaglutide with recurrence upon rechallenge.

Ischemic colitis associated with glucagon-like peptide-1 (GLP-1) receptor agonists is an exceptionally rare condition, with only a few cases reported in the literature. We present the case of a 46-year-old woman treated with oral semaglutide (Rybelsus®) for weight loss who experienced three episodes of abdominal pain and hematochezia temporally associated with drug exposure. The third episode, which occurred after semaglutide was reintroduced, led to a confirmed diagnosis based on computed tomography, rectosigmoidoscopy, and histopathological findings consistent with ischemic colitis. Permanent discontinuation of semaglutide was followed by complete clinical resolution without further recurrence. The temporal relationship, improvement after drug withdrawal, and recurrence upon rechallenge support a probable causal association. This case highlights the need to consider ischemic colitis as a potential rare adverse effect of semaglutide.