Clinical, laboratory, serological, and histological profile of sprue-like enteropathy associated with olmesartan use

Saéz-González, Esteban; Jaime, Francia Carolina Díaz; Antoñana, Adolfo del Val

doi:10.17235/reed.2016.4340/2016

Cited by 10 publications

(26 citation statements)

References 5 publications

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“…There is often a partial response to corticosteroid therapy (45–95% patients) . Following cessation of olmesartan, clinical resolution of symptoms is almost complete (92–100%) in the larger case series . This is associated with histological recovery on re‐biopsy (93–100%) .…”

Section: Discussionmentioning

confidence: 94%

“…The patients raised the question with their treating doctors as to whether the symptoms could be attributed to antihypertensive medication. There have subsequently been several published case series and case reports of olmesartan‐associated duodenal villous atrophy describing over 100 patients with this condition. The most striking feature of presentation is the presence of severe watery diarrhoea, usually occurring in association with weight loss .…”

Section: Discussionmentioning

confidence: 99%

“…There have subsequently been several published case series and case reports of olmesartan‐associated duodenal villous atrophy describing over 100 patients with this condition. The most striking feature of presentation is the presence of severe watery diarrhoea, usually occurring in association with weight loss . Rates of nausea and vomiting are variable (30 to 50% patients) and there are also variable reports of abdominal pain (40–75% patients) .…”

Section: Discussionmentioning

confidence: 99%

“…The most striking feature of presentation is the presence of severe watery diarrhoea, usually occurring in association with weight loss . Rates of nausea and vomiting are variable (30 to 50% patients) and there are also variable reports of abdominal pain (40–75% patients) . Duration of prior exposure to olmesartan is prolonged, with a mean duration of exposure of about 3 years (range 6 months to 11.5 years) .…”

Section: Discussionmentioning

confidence: 99%

“…Rates of nausea and vomiting are variable (30 to 50% patients) and there are also variable reports of abdominal pain (40–75% patients) . Duration of prior exposure to olmesartan is prolonged, with a mean duration of exposure of about 3 years (range 6 months to 11.5 years) . Patients are usually aged in their 60s and 70s (range 46–91 years) with an approximate equal sex distribution.…”

Section: Discussionmentioning

confidence: 99%

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Olmesartan‐associated duodenal villous atrophy, an emerging clinical issue

Shukla

Moore

Gabb

2020

Internal Medicine Journal

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Duodenal villous atrophy with olmesartan was described in 2012, 10 years following registration of olmesartan. Clinical features are severe watery diarrhoea, usually occurring in association with weight loss. Onset is delayed, with a mean duration of prior exposure to olmesartan of 3 years. Diagnosis may be delayed. Symptoms resolve over weeks following cessation of olmesartan. Epidemiological studies suggest increased risk with olmesartan, rather than a class effect of all angiotensin receptor blockers. Postmarketing surveillance for drug safety remains important.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Olmesartan‐associated duodenal villous atrophy, an emerging clinical issue

Shukla

Moore

Gabb

2020

Internal Medicine Journal

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Coeliac disease enteropathy and symptoms may be aggravated by angiotensin receptor blockers in patients on a gluten‐free diet

et al. 2021

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Background: Angiotensin receptor blocker-associated enteropathy (ARB-e) is an increasingly recognised clinical entity with symptoms and histological findings identical to coeliac disease (CD). There is evidence to suggest immune-mediated mucosal injury in ARB-e with a high prevalence of DQ2/DQ8; however, as IgA anti-tissue transglutaminase (anti-TTG) is usually negative, an insult other than TTG-mediated injury is suspected. The impact of ARBs on disease activity in patients with CD is not known.Objective: To assess the effect of ARB exposure on patients with established CD. Methods: A patient record search of 1142 individual patients attending a dedicated coeliac clinic from 2010 to the present identified 59 patients treated with ARB.Those with CD confirmed by serology (TTG + ve/EMA + ve) and histopathology (Marsh criteria) were included (n = 40, 0.52%). Data collected included disease duration, compliance with gluten-free diet (GFD), reported symptoms (diarrhoea, weight loss and abdominal pain), surrogate markers of absorption (Vitamin D, Iron, Calcium and Haemoglobin), in addition to anti-TTG titre and histological grade at last follow up. Patients were age and sex-matched in a 1:2 ratio with CD patients not taking ARBs (controls), with comparable rates of disease duration and compliance with GFD. Results:The ARB and control groups were matched in terms of age (mean 66.2 years) and gender (female 63%). Strict compliance with GFD was reported in 55% and 56%, respectively. Persistent symptoms were reported in 10/40 (25%) of the ARB group compared with 7/82 (9%) of controls (p = 0.0181). There were lower rates of mucosal healing (Marsh grade 0) in the ARB group (36% n = 11) compared to controls (55%, n = 33). There was no significant difference in anti-TTG titres.Surrogate markers of absorption were comparable across the groups, except for Vitamin D which was lower in those taking olmesartan (p = 0.0015).This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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