Background <p>As the prevalence of obesity rises among patients with inflammatory bowel disease (IBD), concerns have emerged regarding the gastrointestinal safety of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), which are increasingly used for diabetes and weight management.</p> Methods <p>We conducted a retrospective cohort study of adult patients with IBD on GLP-1 RA therapy within a large academic medical system between 2010 and 2024. We compared gastrointestinal adverse events—including ileus or bowel obstruction, bowel surgery, IBD-related hospitalization, and escalation of medical therapy—occurring in the one-year period preceding and following GLP-1 RA exposure, which was defined by at least two prescriptions within 90&#xa0;days.</p> Results <p>Among 271 patients (median age 62.8&#xa0;years; 62% female; 64% ulcerative colitis), 80 completed 12&#xa0;months and an additional 168 completed 6&#xa0;months of GLP-1 RA therapy. Semaglutide was the most common agent (58%), followed by dulaglutide (28%), tirzepatide (14%), and liraglutide (1%). No significant difference in gastrointestinal adverse event rates was observed between pre- and post-treatment intervals when normalized for exposure time (<i>p</i> ≥ 0.10 for all comparable adverse events). Median BMI declined modestly from 33.8 to 33.4&#xa0;kg/m² at 12&#xa0;months (<i>p</i> = 0.20). Subgroup analyses by agent, sex, IBD type, and GLP-1 RA indication yielded similar findings.</p> Conclusions <p>GLP-1 RA therapy does not increase gastrointestinal adverse events in patients with IBD over 12&#xa0;months, supporting its safety in this population.</p>