Semaglutide for treatment of intractable diarrhea of different etiologies: a case series of 30 patients.

OBJECTIVES: Diarrhea is common and can exert a profound negative impact on social life due to unpredictable bowel movements and fecal incontinence. Liraglutide has been documented to be effective in patients with bile acid diarrhea (BAD), but documentation for the effect of semaglutide in patients with unspecific diarrhea is lacking. We report experiences with compassionate use of weekly semaglutide in patients with diarrhea of different etiologies. METHODS: Our cases comprised 15 patients with BAD, nine with idiopathic diarrhea, four with short bowel syndrome, two with collagenous colitis and one with radiation enteritis. All patients had undergone routine work-up for chronic diarrhea. Despite the use of anti-diarrheal agents, all patients were severely handicapped in social functioning and work-life due to extreme urgency, nocturnal diarrhea and fecal incontinence. After informed consent, the patients started treatment with semaglutide 0.25 mg every seven days titrated to an individually tailored dosage. RESULTS: After semaglutide was initiated, the median number of daily bowel movements decreased from 8 (interquartile range (IQR) 5-12) to 2 (IQR 1-3),  < .0001. All patients reported an almost immediate relief of urgency, fecal incontinence and nocturnal diarrhea. Fourteen patients shortened their dosing interval of semaglutide to every fifth or sixth day due to a time-dependent decrease in effect. One patient stopped treatment due to nausea, and in another, the dosage was reduced due to constipation. CONCLUSION: Semaglutide may represent a rational symptomatic treatment option for selected patients with severe diarrhea, including those with BAD, short bowel syndrome and idiopathic diarrhea.