In 55 trials, gallstones rose, reflux probably did, pancreatitis not
In 55 placebo-controlled trials of 106,395 people, gallstones rose by about half and reflux probably about doubled, with little or no effect on pancreatitis or a stalled stomach.
What the study found
Gallstones and probably reflux went up; the scarier gut risks did not
In 55 placebo-controlled trials of 106,395 people, semaglutide's class raised gallstones by about half and probably about doubled reflux, about 2 and 4 extra cases per 1,000, with little or no effect on pancreatitis, bowel obstruction or gastroparesis, the stalled stomach of the headlines.
The caveat · Mostly too short for rare harms
This pools the whole drug class rather than semaglutide alone. Randomised trials screen out higher-risk patients and are mostly too short to catch rare events, so finding no signal for pancreatitis is weaker than showing there is none. The subgroups on weight-loss doses did show larger effects, but not significantly so, which leaves the dose question open.
What we don't know
Whether semaglutide raises rare serious gut harms is unsettled. Pooled trials find little or no rise in pancreatitis, obstruction or a stalled stomach but mostly ran too short for rare events; the cohort that found rises cannot size them.