Severe enteropathy with villous atrophy in prolonged mefenamic acid users – a currently under-recognized in previously well-recognized complication

Abstract

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Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus

“…Conditions with insufficient evidence for causing VA were also identified (group III). Online supplemental table 1 shows the list of enteropathies for which the established threshold for agreement was not reached 27–34. For these conditions, a diagnostic category (as per table 1) could not be assigned.…”

The Role of the Gluten-Free Diet in the Management of Seronegative Enteropathy

“…Autoimmune and immune-mediated diseases Autoimmune enteropathy [16] Crohn's disease [17] Collagenous sprue [18] Common variable immune deficiency (CVID) [19] Infectious or probably infectious diseases Giardia lamblia infection [20] Helicobacter pylori infection [17] Post-viral enteropathy [21] Tuberculosis [22] Small intestinal bacterial overgrowth [23] HIV-enteropathy [24] Whipple disease [25] Tropical sprue [26] Iatrogenic causes Medication (angiotensin II receptor blockers [27], mefenamic acid [28], azathioprine [29], methotrexate [30], mycophenolate mofetil [31]) Chemotherapy [32] Radiotherapy [33] Graft versus host disease [34] Inflammatory disease Peptic duodenitis [35] Eosinophilic gastroenteritis [36] Neoplastic Small intestinal lymphoma [37] Other Amyloidosis [38] Malnutrition [39] Food allergy (cow's milk, soy) [20] According to the few studies available on the subject, the frequency of occurrence of SNVA varies considerably, particularly between adult and child populations. CD is diagnosed in 28-45% of adults with SNVA [5,13,40]; among the remainder, the most common causes of non-CD SNVA are believed to be inter alia medication-related enteropathy and infectious causes, including giardiasis and small intestinal bacterial overgrowth, peptic duodenitis, and collagenous sprue [5,13,40,41].…”

“…In patients with SNVA, a detailed medical history allows more focussed diagnostic procedures to be used and limits the need for expensive and often poorly available laboratory testing. A number of drugs can cause drug-induced enteropathy, such as non-steroidal anti-inflammatory drugs (NSAIDs) and angiotensin II receptor blockers, as well as azathioprine, methotrexate, and mycophenolate mofetil [27][28][29][30][31]. As some forms of SNVA unrelated to gluten can develop as a consequence of an infection, a history of recent travel and correlation with other infectious symptoms should be carefully evaluated.…”

Clinical phenotype and mortality in patients with idiopathic small bowel villous atrophy: a dual-centre international study

“…Enterocyte antibodies were negative and serum immunoglobulin levels normal, thus ruling out AE and CVID respectively. None of the patients were taking drugs known to be responsible for VA, namely ARBs, NSAIDS, methotrexate, mycophenolate [5,6,[17][18][19][20][21][22]. Drug history was carefully reassessed particularly in those patients diagnosed before 2012, as to exclude a contributing role of olmesartan therapy [6].…”

“…Although small-bowel VA is due to CD and its complications in the vast majority of cases, these are not the only causes of VA and other non-coeliac enteropathies must be thoroughly investigated [5][6][7][8][9][10][11]. This is the case for autoimmune enteropathy (AE) [12,13], enteropathy associated with common variable immunodeficiency (CVID) [14,15], medicationrelated enteropathies [16][17][18][19][20][21], infections [22][23][24][25][26], small-bowel bacterial overgrowth [27], some lymphoproliferative disorders primarily affecting the small bowel [28], Crohn's disease [29], tropical sprue [30] and collagenous sprue [31]. Some contemporary reports suggest that overall mortality in non-coeliac enteropathies with VA is higher than in CD [5,8,10].…”