Could HLA-DQ Suggest Why Some Patients Have Olmesartan-Related Diarrhea and Others Don't?

Olmesartan-associated enteropathy (OAE) is increasingly being recognised as a major differential diagnosis in patients with villous atrophy and negative coeliac disease (CD) serology. OAE and positive coeliac markers have rarely been reported. We report a case of diarrhoea and small bowel villous blunting associated with a transient elevation of antitissue transglutaminase antibody (ATTG). On discontinuation of olmesartan, symptoms improved, repeat biopsies were normal and levels of ATTG also returned normal. We discuss a possible explanation for the transient elevation in ATTG and the significance of considering OAE/CD overlap.

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“…Of the reported cases, only three tested positive for ATTG. Interestingly one patient had ATTG deposits on duodenal biopsy 6–9…”

Section: Discussionmentioning

confidence: 99%

Case of olmesartan-associated enteropathy and transient positive antitissue transglutaminase serology

et al. 2018

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“…Olmesartan is metabolized by the esterases in the gastrointestinal mucosa, and presents a greater selective binding to the AT 1 receptor (about 4.2-fold and 203-fold more potent compared to valsartan or losartan, respectively) allowing circulating angiotensin II to bind AT2 receptor, driving an epithelial cell apoptosis by decreasing mucosa levels of TFG-β, which plays an important role in intestinal homeostasis. 4-6,9 In addition, a case series by Tapia et al 2 found around 80% of patients presented with positive HLA DQ2/DQ8 haplotypes; similarly, Marco-Marqués et al 10 tested HLA typing in 9/11 patients with OAE and found that 100% were positive for HLA DQ2 or -DQ8. Taking all together these findings might suggest a potential genetic susceptibility that may increase the long-term risk of developing this entity.…”

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confidence: 97%

“Weight Loss Syndrome”: A Case of Olmesartan-Associated Enteropathy

Oblitas

Santos-Martínez

Moreno-Mijares

et al. 2021

Journal of Pharmacy Practice

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Blood pressure control aims to reduce the risk of long-term cardiovascular events. Olmesartan medoxomil is an oral prodrug that belongs to the angiotensin II receptor blockers (ARBs) family and blocks the renin-angiotensin-aldosterone system by antagonizing the angiotensin II (AT) type 1 receptor. 1 Olmesartan-associated enteropathy (OAE), was described for the first time in 2012 by Rubio-Tapia et al. in 22 patients with chronic diarrhea and weight loss treated with olmesartan. Serological screening tests for celiac disease were negative, and there was no response to a gluten-free diet. Endoscopic biopsy showed villous atrophy and mucosal inflammation similar to sprue-like enteropathy. Clinical response was demonstrated in all patients after drug discontinuation. In July 2013 the U.S. Food and Drug Administration issued a postmarketing warning highlighting the importance of this new entity. 2 We present a case of a 76-year-old man with a history of arterial hypertension treated with olmesartan/hydrochlorothiazide 40/12.5mg/daily during 2 years, who presented with 2-month history of weight loss of 15 kg, vomiting and watery diarrhea, up to 4 stools per day, without bleeding, mucus or pus, and afebrile. Stool sample culture found no microbiological isolations. Laboratory tests showed hemoglobin 14 g/dL, white blood cells 9,100/mcL, platelets 259,000/mcL, creatinine 0.7 mg/dL with no electrolyte imbalance, albumin 3.0 g/dL, C-reactive protein 1.5 mg/dL, thyroid-stimulation hormone 0.5 mUI/L and T4-free 1.3 nanogram/dL. Biomarkers were normal. Autoimmune tests with anti-nuclear antibodies and anti-DNA antibodies were negative. Serological tests for celiac disease (CD) were negative. Human leukocyte antigen (HLA) DQ2 typing was positive. Abdominal computed tomography showed a diffuse thickening throughout the entire colon and terminal ileum. Gastroscopy and colonoscopy evinced villous atrophy in duodenum and unspecific recto-colon-ileitis, respectively. Biopsy samples from gastric, ileum and colon showed no malignancy but severe chronic nonspecific inflammatory damage with the presence of lymphocytes, plasma cells and granulocytic infiltration. Helicobacter pylori was not visualized (Figure 1).During hospitalization, watery diarrhea persisted in spite of a gluten-free diet. Parenteral nutrition was required initially due to severe weight loss and oral intolerance. Clinical remission was observed after withdrawal of olmesartan. Control

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Pharmacy and therapeutics committees strategy to address olmesartan safety issues at a primary care level

et al. 2020

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Could HLA-DQ Suggest Why Some Patients Have Olmesartan-Related Diarrhea and Others Don't?

Cited by 8 publications

References 3 publications

Case of olmesartan-associated enteropathy and transient positive antitissue transglutaminase serology

Case of olmesartan-associated enteropathy and transient positive antitissue transglutaminase serology

“Weight Loss Syndrome”: A Case of Olmesartan-Associated Enteropathy

Pharmacy and therapeutics committees strategy to address olmesartan safety issues at a primary care level

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