{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T14:45:15Z","timestamp":1793371515544,"version":"4.5.0"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Glucagon-like peptide 1 receptor agonists such as tirzepatide are increasingly prescribed to treat type 2 diabetes mellitus and obesity because they improve glycemic control and promote weight loss. Although gastrointestinal adverse effects such as nausea, vomiting, constipation, and delayed gastric emptying are well recognized, very rare cases of pneumatosis intestinalis have also been reported in association with this class of medications. We report the first documented histologic diagnosis of a possible tirzepatide-associated pneumatosis intestinalis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 55-year-old man with obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea underwent colonoscopy for evaluation of abdominal pain, constipation, and anal fissures. He had been receiving tirzepatide therapy for approximately 1 year and experienced a 49-pound weight loss. Colonoscopy demonstrated mucosal edema of the cecum and ascending colon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Biopsy specimens of the colon revealed mucosal and submucosal air-filled spaces associated with foreign body\u2013type giant cell reactions and mixed inflammatory infiltrates, including eosinophils and neutrophils, consistent with pneumatosis intestinalis. The patient lacked other recognized risk factors for pneumatosis intestinalis, and his symptoms improved following discontinuation of tirzepatide.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As the use of tirzepatide and related glucagon-like peptide 1 receptor agonists continues to increase, awareness of this rare side effect and its characteristic histologic features should facilitate prompt recognition and accurate diagnosis. Reporting these rare events remains essential to refine the safety profile of these increasingly used medications and improve our understanding of their long-term gastrointestinal effects in broader patient populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajcp\/aqag108","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T11:36:52Z","timestamp":1789817812000},"source":"Crossref","is-referenced-by-count":1,"title":["Tirzepatide-induced pneumatosis intestinalis: a rare but clinically significant gastrointestinal adverse\u00a0effect"],"prefix":"10.1093","volume":"166","author":[{"given":"Ari","family":"Kassardjian","sequence":"first","affiliation":[{"name":"Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center , Woodland Hills, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafis","family":"Shafizadeh","sequence":"additional","affiliation":[{"name":"Department of Pathology, Southern California Permanente Medical Group, Woodland Hills Medical Center , Woodland Hills, CA,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"key":"2026101300462098200_aqag108-B1","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1007\/s13300-020-00981-0","article-title":"The role of tirzepatide, dual GIP and GLP-1 receptor agonist, in the management of type 2 diabetes: the SURPASS clinical trials","volume":"12","author":"Min","year":"2021","journal-title":"Diabetes Ther"},{"key":"2026101300462098200_aqag108-B2","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1002\/oby.23612","article-title":"Tirzepatide for the treatment of obesity: rationale and design of the SURMOUNT clinical development program","volume":"31","author":"Le Roux","year":"2023","journal-title":"Obesity (Silver Spring)"},{"key":"2026101300462098200_aqag108-B3","doi-asserted-by":"publisher","first-page":"1043789","DOI":"10.3389\/fendo.2022.1043789","article-title":"Association between different glucagon-like peptide-1 receptor agonists and gastrointestinal adverse reactions: a real-world disproportionality study based on the FDA adverse event reporting system database","volume":"13","author":"Liu","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"2026101300462098200_aqag108-B4","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1111\/dom.12824","article-title":"Occurrence of nausea, vomiting and diarrhoea reported as adverse events in clinical trials studying glucagon-like peptide-1 receptor agonists: a systematic analysis of published clinical trials","volume":"19","author":"Bettge","year":"2017","journal-title":"Diabetes Obes Metab"},{"key":"2026101300462098200_aqag108-B5","doi-asserted-by":"publisher","first-page":"e001858","DOI":"10.1136\/tsaco-2025-001858","article-title":"Benign small bowel pneumatosis intestinalis: report of a rare adverse effect of tirzepatide","volume":"10","author":"Newcomer","year":"2025","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026101300462098200_aqag108-B6","doi-asserted-by":"publisher","first-page":"S2484","DOI":"10.14309\/01.ajg.0000965200.35581.63","article-title":"Weight loss at a price: tirzepatide-induced pneumatosis intestinalis","volume":"118","author":"Kolli","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"2026101300462098200_aqag108-B7","doi-asserted-by":"publisher","first-page":"luag019","DOI":"10.1210\/jcemcr\/luag019","article-title":"Pneumatosis intestinalis in a patient treated with a glucagon-like peptide-1 receptor agonist and prednisone","volume":"4","author":"Sutton","year":"2026","journal-title":"JCEM Case Rep"},{"key":"2026101300462098200_aqag108-B8","doi-asserted-by":"publisher","first-page":"e01579","DOI":"10.14309\/crj.0000000000001579","article-title":"Semaglutide-associated gastric pneumatosis","volume":"12","author":"Turunen","year":"2025","journal-title":"ACG Case Rep J"},{"key":"2026101300462098200_aqag108-B9","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/TA.0000000000004966","article-title":"Pneumatosis intestinalis: benign or dire? What you need to know","volume":"101","author":"Tung","year":"2026","journal-title":"J Trauma Acute Care Surg"},{"key":"2026101300462098200_aqag108-B10","first-page":"1747","article-title":"Pneumatosis intestinalis: a review","volume":"90","author":"Heng","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"2026101300462098200_aqag108-B11","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.3390\/cancers14071666","article-title":"Pneumatosis intestinalis induced by anticancer treatment: a systematic review","volume":"14","author":"Gazzaniga","year":"2022","journal-title":"Cancers (Basel)"},{"key":"2026101300462098200_aqag108-B12","doi-asserted-by":"publisher","first-page":"34","DOI":"10.2337\/db15-0973","article-title":"Knockdown of GLP-1 receptors in vagal afferents affects normal food intake and glycemia","volume":"65","author":"Krieger","year":"2016","journal-title":"Diabetes"}],"container-title":["American Journal of Clinical Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/166\/4\/aqag108\/71828517\/aqag108.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajcp\/article-pdf\/166\/4\/aqag108\/71828517\/aqag108.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:46:41Z","timestamp":1791866801000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajcp\/article\/doi\/10.1093\/ajcp\/aqag108\/8906007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":12,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,10,10]]}},"URL":"https:\/\/doi.org\/10.1093\/ajcp\/aqag108","relation":{},"ISSN":["0002-9173","1943-7722"],"issn-type":[{"value":"0002-9173","type":"print"},{"value":"1943-7722","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,10]]},"article-number":"aqag108"}}