Nutritional Vulnerability in RYGB Unmasked by GLP-1 Therapy.

ACG case reports journal2026PMID: 41767340

View on PubMed DOI: 10.14309/crj.0000000000002032

Plain Language Summary

Case report of life-threatening malnutrition and liver injury in a patient who developed profound micronutrient deficiencies and acute hepatotoxicity requiring ICU care after starting semaglutide following prior Roux-en-Y gastric bypass (RYGB). The 'dual-hit' of GLP-1 RA-reduced intake compounding RYGB malabsorption unmasked nutritional vulnerability requiring parenteral nutrition and eventual bypass reversal. Highlights the critical need for nutritional monitoring before starting semaglutide in post-bariatric surgery patients—a growing and often nutrition-vulnerable patient population.

Abstract

We report a case of life-threatening malnutrition and liver injury in a post-Roux-en-Y gastric bypass patient after initiation of semaglutide, who subsequently developed profound micronutrient deficiencies and acute liver injury requiring ICU care, parenteral nutrition, and endoscopic bypass reversal. This case highlights the potential "dual-hit" risk of GLP-1 receptor agonists in patients with altered gastrointestinal anatomy. Clinicians should closely monitor nutritional status and liver function in postbariatric patients on GLP-1 therapy. Future research should explore safe prescribing practices, risk stratification, and the role of endoscopic interventions in managing severe complications.

Authors

Madej, Juliana; Gonzaga, Ernesto Robalino; Naveed, Mariam

Keywords

GLP-1 receptor agonistRoux-en-Y gastric bypassbariatric surgeryendoscopic bypass reversalmalnutrition-related liver injurysemaglutidesteatohepatitis