Adding Water to the Mill: Olmesartan-Induced Collagenous Sprue—A Case Report and Brief Literature Review

Abstract

Collagenous sprue (CS) is a distinct clinicopathological disorder histologically defined by a thickened subepithelial band (Freeman, 2011). It is a rare condition which has been recently observed in a significant proportion of sprue-like enteropathy associated with olmesartan, a novel entity described by Rubio-Tapia et al. in 2012. CS is historically associated with a poor prognosis (Marthey et al., 2014). However, histological and clinical improvements have been described in most studies with concomitant usage of corticosteroids and/or gluten-free diet (Marthey et al., 2014). We report a unique case of olmesartan-induced collagenous sprue in a 79-year-old man that showed complete histological and clinical remission with the sole withdrawal of the incriminating drug. The literature on this topic is briefly reviewed.

Significant Weight Loss in a Patient Taking Olmesartan: An Unusual Case Report

“…A severe form of intestinal injury with chronic diarrhea due to olmesartan was first described by Rubio-Tapia et al in 2012 [2]. Numerous other reports of olmesartan-associated enteropathy have since appeared in the literature, several of which during the last few years [4][5][6][7][8][9][10][11][12][13][14][15], suggesting that this clinical entity is eventually being more and more recognized. In fact, in 2013, the Food and Drug Administration (FDA) approved label changes to include updated data about the association of olmesartan with sprue-like enteropathy [16].…”

“…Laboratory evaluation is usually indicative of malabsorption with normocytic anemia, hypoalbuminemia and multiple electrolyte abnormalities. Dehydration and acute renal failure are the most frequent causes of hospitalization, even in the Intensive Care Unit (ICU) [6,15]. Other unusual cases of this entity include colonic perforation [24], Wernicke-Korsakoff syndrome due to vitamin B1 malabsorption with minimal gastrointestinal symptoms [25], nonalcoholic steatohepatitis [26] and simultaneous olmesartan-associated uveitis with enteropathy [27].…”

“…Angiotensin II promotes enterocyte apoptosis, suggesting that olmesartan-associated enteropathy results from excess apoptosis of enterocytes. The high affinity of olmesartan for AT1 receptors may explain the greater incidence of enteropathy with this ARB [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Management of Hypertension Using Olmesartan Alone or in Combination

“…The best-known severe adverse event associated with olmesartan is sprue-like enteropathy, according to several case reports and research articles [ 85 – 90 ]. Rubio-Tapia et al firstly reported that 22 olmesartan recipients who suffered from chronic diarrhea could recover from the syndrome after stopping olmesartan therapy [ 91 ].…”

Acute Gastrointestinal Bleeding in Olmesartan-Associated Collagenous Gastroduodenitis: A Potential Endoscopic Complication

“…The etiology of collagenous gastroenteritis is unknown but is suspected to be immune-mediated and may be associated with certain medications including the antihypertensive drug olmesartan, an angiotensin II receptor antagonist [ 2 ]. Several reports in the literature describe cases of olmesartan-associated collagenous duodenitis/sprue [ 3 – 5 ] with fewer reports of olmesartan-associated collagenous gastritis [ 3 , 6 ] and only rare reports involving both the stomach and small bowel [ 3 ]. We herein report a case of olmesartan-associated collagenous gastroduodenitis that was complicated by acute gastrointestinal bleeding during endoscopy.…”