Cutaneous ulcers in association with sprue‐like enteropathy secondary to Losartan

Essien, Francis; Juakiem, Wassem; Tate, Joshua; Roberts, Jared

doi:10.1002/ccr3.4645

Cited by 2 publications

(17 citation statements)

References 13 publications

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“…Finally, three patients showed macroscopic abnormalities at colonoscopy, including one case of ulceration of the proximal colon, 29 one case of non-specific pan-colitis and ileitis 70 and one patient presented erosive ileitis. 103…”

Section: Patients With Villous Atrophy and Mucosal Changes In The Colonmentioning

confidence: 99%

“…The final diagnosis was reached after a median of 5 months, and an acute onset of symptoms leading to diagnosis was present in 10% of patients. Coeliac serology results were reported in 140/183 5,11,13,14,[16][17][18][19][20][21][22]24,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][40]83,84,86,[89][90][91][92][94][95][96][97][98][99][100][101] and were negative in the large majority of cases (138/140, 99%). In only two patients, IgA tissue transglutaminase antibodies were borderline and considered to be irrelevant by the authors.…”

Section: Baseline Clinical Featuresmentioning

confidence: 99%

“…The most commonly involved ARB leading to enteropathy was olmesartan, which accounted for 89.6% of cases. Less commonly other ARBs were implicated, with valsartan being the second most common (3.6% of cases), 31,43,79,88,97,104 followed by telmisartan (2.2%), 20,59,67,104 irbesartan (1.6%), 11,104 losartan (1.6%), 29,68,83 candesartan (1.1%) 11,44 and eprosartan (0.5%). 56 The median duration of ARB therapy before onset of GI symptoms was 36 months (IQR 24-60, range 1-170).…”

Section: Type Of Angiotensin II Receptor Blockermentioning

confidence: 99%

“…VA was present in 164/183 (89%) patients. 5,11,13,14,[16][17][18]20,21,24,25,[27][28][29][30][31][32][33][34][35][36][37][38][39][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][90][91][92][93][94][95][96][97][98][99][100][101][102][103]…”

Section: Duodenal Histopathological Featuresmentioning

confidence: 99%

“…As shown in Table 2, the endoscopic investigations performed in these 183 patients included upper GI endoscopy in 177, 5,11,[13][14][15][16][17][18][19][20][21] colonoscopy in 117 5,11,13,14,16,17,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][40][41][42][44][45][46][47][48][49][50][51][52]57,58,[60][61]…”

Section: Distribution Of Mucosal Changes Throughout the Gi Tractmentioning

confidence: 99%

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Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers

Schiepatti,

Minerba,

Puricelli

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundAlthough enteropathy due to angiotensin II receptor blockers (ARBs) has been known for over 10 years, clinicians' awareness of this condition is still low.AimsTo systematically review the literature about clinical phenotypes, distribution of mucosal changes throughout the gastrointestinal tract and prognosis of enteropathy due to ARBs.MethodsAccording to PRISMA guidelines, we searched PubMed and Embase for relevant articles up to November 6, 2023. We included full‐text papers, letters, case reports and case series describing enteropathy due to ARBs. Patients were classified into subgroups based on endoscopic and histological findings of different regions of the gastrointestinal tract. The protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/TK67C).ResultsWe included 94 articles reporting 183 cases (101 female, mean age at diagnosis 69 ± 10 years). The clinical picture at diagnosis was characterised by severe diarrhoea (97%) and weight loss (84%, median −13 kg), leading to hospital admission in 167 (95%) patients. Olmesartan (90%) was most frequently implicated. Villous atrophy (VA) was reported in 164/183 (89%) patients. One hundred and nine had only VA, 12 had pan‐gastrointestinal involvement, 23 had VA and gastric involvement and 19 had VA and colon involvement (predominantly microscopic colitis). Outcomes were reported for 178/183 (97%) patients, who all recovered clinically on ARBs withdrawal. Histological recovery occurred in all 96 patients with VA at baseline who underwent follow‐up duodenal biopsy.ConclusionsEnteropathy due to ARBs is characterised by severe malabsorption often requiring hospital admission and can involve the entire gastrointestinal tract. Clinician awareness can lead to prompt diagnosis and excellent prognosis.

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Section: Patients With Villous Atrophy and Mucosal Changes In The Colonmentioning

confidence: 99%

Section: Baseline Clinical Featuresmentioning

confidence: 99%

Section: Type Of Angiotensin II Receptor Blockermentioning

confidence: 99%

Section: Duodenal Histopathological Featuresmentioning

confidence: 99%

Section: Distribution Of Mucosal Changes Throughout the Gi Tractmentioning

confidence: 99%

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Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers

Schiepatti,

Minerba,

Puricelli

et al. 2024

Aliment Pharmacol Ther

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Angiotensin II receptor blockers (ARBs) and manufacturing contamination: A retrospective National Register Study into suspected associated adverse drug reactions

Salim

Jones

2022

Brit J Clinical Pharma

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The aim of this study was to determine if any suspected adverse drug reactions (ADRs) observed with the use of angiotensin II receptor blockers (ARBs) could be linked to either (a) their unique respective physicochemical and pharmacological profiles and (b) the recently disclosed suspected carcinogenic manufacturing contaminants found in certain sartan drug class batches. Methods:The pharmacology profiles of ARBs were data-mined from the Chemical Database of bioactive molecules with drug-like properties, European Molecular Biology Laboratory (ChEMBL). Suspected ADR data (from 01/2016-10/2022, inclusive) and prescribing rates of ARBs over a 5-year prescribing window (from 09/2016 to 08/2021, inclusive) were obtained via analysis of the United Kingdom Medicines and Healthcare products Regulatory Authority (MHRA) Yellow Card drug analysis profile and Open prescribing databases, respectively. Results:The overall suspected ADRs and fatalities per 100 000 prescriptions identified across the ARBs studied were found to be different between the sartan drug class members (chi-squared test, P < .05). There is a greater relative rate of reports for valsartan across all investigated organ classes of ADRs, than other ARBs, despite valsartan's more limited pharmacological profile and similar physicochemical properties to other sartans. The disparity in ADR reporting rates with valsartan vs other ARBs could be due to the dissimilarity in formulation excipients, patient factors and publicity surrounding batch contaminations, amongst others. Cancer-related ADRs and fatalities per 100 000 prescriptions identified across the ARBs studied are not statistically significant (chi-squared test, P > .05) based on the datasets used over the 5-year period. Conclusion:No connection between ARB pharmacology and their suspected ADRs could be found. No conclusion between sartan batch contaminations and increased suspected cancer-related ADRs was found.

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Cutaneous ulcers in association with sprue‐like enteropathy secondary to Losartan

Abstract: Losartan is an angiotensin II receptor blocker (ARB) which may cause severe sprue‐like enteropathy (SLE) with skin manifestation. Clinicians should be informed of this side effect and its reversibility after cessation of the drug.

Cited by 2 publications

References 13 publications

Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers

Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers

Angiotensin II receptor blockers (ARBs) and manufacturing contamination: A retrospective National Register Study into suspected associated adverse drug reactions

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