Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers

The AT1 Receptor Blocker Telmisartan Reduces Intestinal Mucus Thickness in Obese Mice

“…However, albumin excretion was not impaired in our study, and diarrhea has never been identified in the past in rats or mice when TEL was given even in high doses ( Muller-Fielitz et al, 2011 ; Muller-Fielitz et al, 2012 ; Muller-Fielitz et al, 2014 ; Muller-Fielitz et al, 2015 ; Schuchard et al, 2015 ; Winkler et al, 2016 ; Schuster et al, 2018 ; Dapper et al, 2019 ; Gustaityte et al, 2019 ; Rawish et al, 2020 ; Beckmann et al, 2021 ; Huber et al, 2021 ). Thus, our findings tend to confirm the data of Malfertheiner et al ( Malfertheiner et al, 2018 ), who found that ARBs indeed induced ("Sprue-like enteropathy") but to a much lesser extent, as observed by others ( Rubio-Tapia et al, 2012 ; Costetti et al, 2021 ).…”

“…We also cannot confirm the observations on inflammatory effects under ARBs ( Costetti et al, 2021 ). Even though we did not measure intestinal cytokine levels, plasma levels of cytokines in plasma (serving as a surrogate parameter) remained unchanged, except of the pro-inflammatory cytokine IL-6 ( Schett, 2018 ).…”

“…Indeed, the ARB olmesartan increased both the risk for enteropathy and lymphocytosis and the eosinophil count in duodenal mucosa of patients, all together indicating inflammatory processes. These observations led the authors to speculate that weight loss in olmesartan-treated patients is related to malabsorption and a higher risk for acute diarrhea ( Costetti et al, 2021 ). However, albumin excretion was not impaired in our study, and diarrhea has never been identified in the past in rats or mice when TEL was given even in high doses ( Muller-Fielitz et al, 2011 ; Muller-Fielitz et al, 2012 ; Muller-Fielitz et al, 2014 ; Muller-Fielitz et al, 2015 ; Schuchard et al, 2015 ; Winkler et al, 2016 ; Schuster et al, 2018 ; Dapper et al, 2019 ; Gustaityte et al, 2019 ; Rawish et al, 2020 ; Beckmann et al, 2021 ; Huber et al, 2021 ).…”

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.…”