S3890 Weight Loss at a Price: Tirzepatide-induced Pneumatosis Intestinalis

• DOI: 10.14309/01.ajg.0000965200.35581.63
• Publication Date: 2023-10-19T02:37:39Z
• Authors: Sindhura Kolli; Dhineshreddy Gurala; Jean Chalhoub; Sherif Andrawes
• Keywords: Ascending colon; Pneumatosis Intestinalis; Transverse colon; Pneumatosis Cystoides Intestinalis

Introduction: Tirzepatide is a dual gastric inhibitory peptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist (RA) used off-label for weight loss. Its GLP-1 activity decreases emptying (GE) causing satiety but can increase colonic stool burden. Unchecked, our patient presented with the first reported case of tirzepatide-induced pneumatosis intestinalis (PI). Case Description/Methods: A 30-year-old female hypothyroidism recent 80 pound loss using tirzepatide 6 months RLQ abdominal pain, distention, emesis. Abnormal labs included CRP 138, ESR 35, WBC 11 neutrophilic predominance. Computed tomography (CT) abdomen showed large bowel obstruction an cm dilated colon filled fecal material. nasogastric tube was placed decompression. Once patient's symptoms improved, colonoscopy performed decompression revealed significant PI extending from ascending to descending multiple semi-circular ulcers in sigmoid (Figure 1). Patient treated conservatively antibiotics, rest, low residue diet no further issues. Discussion: Introduced 2022, we are midst tirzepatide’s phase 4 post-marketing surveillance stage where individual pharmacokinetics come into play. Only its RA portion has effect on delayed GE. In mice, that had demonstrated tachyphylaxis by weeks at current approved doses. Yet, persistent susceptibility GE despite consistent use. The decreased motility obstructive load resulted stercoral ulcers. defined gas within walls intestine forming submucosal cysts cause mucosal pressure Patients present asymptomatically delaying diagnosis until complications as pain or hematochezia. diagnosed presence intramural XR CTs, confirmed endoscopically pale bluish surface deflate when biopsied. Treatment includes addressing etiology, use elemental diet. Exploratory laparotomy reserved warning signs peritonitis, portal venous gas, lactate >2 metabolic acidosis. Though it may seem like benign presentation, escalate perforation without early intervention. Monitoring prolonged constipation while key preventing onset PI.Figure 1.: Erythema ulcer (yellow arrows) air-filled indicative (blue green arrows).