A randomized trial showed the GLP-1 peptide drug liraglutide was more effective than standard bile acid sequestrant therapy for bile acid diarrhea, opening a new potential use for this drug class.
Liraglutide beat standard-of-careIn a 6-week randomized controlled trial, the GLP-1 RA liraglutide was superior to colesevelam (standard treatment) for reducing bile acid diarrhea symptoms
What the researchers found
This review highlights that a 6-week randomized controlled trial demonstrated the GLP-1 receptor agonist liraglutide was superior to colesevelam (the standard bile acid sequestrant treatment) for reducing bile acid diarrhea (BAD) symptoms. The authors review the broader literature on GLP-1 RAs for BAD, discuss potential mechanisms of action, and argue that newer, more potent GLP-1 RAs could offer even greater benefits for this underserved patient population.
Why it matters
Bile acid diarrhea affects millions of people but is underdiagnosed and poorly treated — current standard therapy (bile acid sequestrants) is only partially effective and poorly tolerated. Repurposing GLP-1 receptor agonist peptides for BAD would provide a new treatment option for a debilitating condition, and it represents yet another expanding indication for this blockbuster drug class beyond diabetes and obesity.
How the study worked
Narrative review of published literature on GLP-1 receptor agonists in bile acid diarrhea treatment, including the authors' own 6-week RCT comparing liraglutide to colesevelam. The review covers mechanisms of action, knowledge gaps, and the rationale for testing newer GLP-1 RAs in BAD.
Who was studied
Review article focusing on patients with bile acid diarrhea
What this study cannot tell us
The evidence base for GLP-1 RAs in BAD is still very limited — primarily based on a single 6-week RCT. The review notes significant knowledge gaps and calls for further clinical evidence. Long-term efficacy and safety of GLP-1 RAs specifically for BAD patients (who may not have diabetes or obesity) are unknown.
How to read the evidence
This is a moderate-grade review that references a key RCT. The RCT evidence is promising but limited to a single 6-week trial. The broader review identifies significant knowledge gaps and the need for further clinical studies.
When this study was published
Published in 2025, this is very recent and timely given the explosive growth of GLP-1 RA prescribing. It represents an emerging application of these peptide drugs.
The bigger picture
GLP-1 receptor agonists continue to find new applications beyond their original diabetes indication — obesity, heart disease, kidney disease, and now potentially bile acid diarrhea. This expanding therapeutic landscape for peptide drugs reflects how modulating the GLP-1 pathway has wide-ranging physiological effects, with gastrointestinal motility being one of the most relevant for BAD treatment.
Questions still open
- Would newer, more potent GLP-1 RAs like semaglutide be even more effective for bile acid diarrhea than liraglutide?
- What is the optimal dose of GLP-1 RAs for BAD — is the diabetes/obesity dose appropriate, or does BAD require different dosing?
- How do the GI side effects common with GLP-1 RAs (nausea, constipation) interact with BAD symptoms — could some side effects actually be beneficial?
Common questions
What is bile acid diarrhea and how common is it?
How might GLP-1 drugs help with diarrhea?
Read the original research
Treatment of Bile Acid Diarrhea With Glucagon-Like Peptide 1 Receptor Agonists: A Promising Yet Understudied Approach.
Clinical and translational gastroenterology, 16(3), e00815
Citation
Ellegaard, Anne-Marie; Kårhus, Martin L; Winther-Jensen, Matilde; Lund, Asger B; Knop, Filip K. (2025). Treatment of Bile Acid Diarrhea With Glucagon-Like Peptide 1 Receptor Agonists: A Promising Yet Understudied Approach.. Clinical and translational gastroenterology, 16(3), e00815. https://doi.org/10.14309/ctg.0000000000000815