Enteropathy Associated with Olmesartan

Abstract

The recognition of an enteropathy caused by olmesartan is recent. It was first described in 2012 by the Mayo Clinic, which presented 22 clinical cases. Olmesartan is a highly prescribed drug and the differential diagnosis of a sprue-like enteropathy is very wide, so it is important to be aware of this pathology.We report a case of a 67-years-old man, with arterial hypertension under treatment with olmesartan, with a 4-months history of diarrhea and weight lost. He was admitted three times in our Department during this period of time. An initial diagnosis was made of lymphocytic colitis but he did not respond to treatment with corticosteroids. There was a high suspicion of celiac disease, so the patient started a gluten-free diet but still there were no symptomatic changes. The patient underwent several blood and imaging tests which were negative. Due to the suspicion of an enteropathy caused by drugs, olmesartan was stopped and the patient showed a significant improvement of his symptoms.The exact pathophysiology of this entity remains to be elucidated. It may affect all gastrointestinal tract and mimic a refractory celiac disease as well as a lymphocytic colitis due to similar symptoms and histology. It is expected more cases like this in the future due to high use of olmesartan in current clinical practice.So, it is important to all gastroenterologists to be aware of this pathology and take it into consideration when putting together a differential diagnosis.

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

“…Olmesartan-associated enteropathy (OAE) was first described in a case series by Rubio-Tapia et al 2 in 2012; subsequently, the US Food and Drug Administration3 included severe sprue-like enteropathy as an adverse effect of olmesartan. The diagnosis of OAE relies on high clinical suspicion, demonstration of histological changes associated with enteropathy and negative coeliac disease (CD) serology 4. It is unclear if there is a relationship between OAE and CD; however, given the pathogenesis of OAE, an overlap between the two conditions may be possible.…”

Olmesartan‐associated duodenal villous atrophy, an emerging clinical issue

“…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 .…”

Sprue-Like Enteropathy Associated with Olmesartan: An Unrecognized Emerging Drug-Induced Enteropathy?

“…We read with great interest the case reports by da Silva et al 1 , Carneiro et al 2 and Eusébio et al 3 published in the late issue of GE Portuguese Journal of Gastroenterology .…”