Olmesartan-Induced Spruelike Enteropathy: An Emerging Cause of Small Bowel Injury

Malik, Adnan; Inayat, Faisal; Malik, Muhammad Imran; Afzal, Muhammad; Azrak, M. Fuad

doi:10.7759/cureus.9347

Cited by 4 publications

(23 citation statements)

References 16 publications

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“…Olmesartan is a widely used drug for the treatment of high blood pressure [3]. OIE was first described by Rubio-Tapia et al in 2012 [1][2][6][7][8]. Since then, several case reports and small case series have been documented [3,6].…”

Section: Discussionmentioning

confidence: 99%

“…OIE was first described by Rubio-Tapia et al in 2012 [1][2][6][7][8]. Since then, several case reports and small case series have been documented [3,6]. Due to its rarity, the lack of awareness of the disease commonly results in delayed diagnosis [9].…”

Section: Discussionmentioning

confidence: 99%

“…One of the proposed mechanisms involves a cellmediated immune response that damages the small intestinal brush border [2][3]. In addition, it is thought that the ARB class of drugs has an inhibitory action of transforming growth factor-beta (TGF-β), which is important for the gut homeostasis and apoptosis of enterocytes due to disproportionate activation of type 2 angiotensin II (AT2) receptors after blockage of type 1 angiotensin II receptors (AT1) [2,[4][5][6]8].…”

Section: Discussionmentioning

confidence: 99%

“…Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms, including chronic severe non-bloody diarrhea and significant weight loss that is unresponsive to a glutenfree diet [1][2][5][6]. The time between olmesartan exposure and the onset of symptoms usually ranges from few months to five years [1].…”

Section: Introductionmentioning

confidence: 99%

“…Typically, celiac serology (including anti-transglutaminase, anti-gliadin, and anti-endomysial antibodies) is always negative, antinuclear antibodies may be positive, and the majority of patients may have either HLA-DQ2 or DQ8 haplotypes [1,[4][5]. Histopathological findings include total or partial duodenal villous atrophy, mucosal granulocytic infiltration, and a thickened subepithelial collagen layer [1,6].…”

Section: Introductionmentioning

confidence: 99%

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Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

Sotiropoulos

Sakka

Διαμαντοπούλου

et al. 2021

Cureus

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Olmesartan, an angiotensin II receptor blocker indicated in the treatment of hypertension, has been associated with a seronegative sprue-like enteropathy that should be considered in the differential diagnosis of patients with unexplained chronic diarrhoea. It typically presents with severe chronic diarrhoea, considerable weight loss, and villous atrophy on biopsy and may be difficult to recognize because of its clinical and histological similarities to other clinical entities. Practically, discontinuation of the drug leads to dramatic recovery of the symptoms. We report a 76-year-old Caucasian female who was admitted to our hospital with complaints of chronic diarrhea and significant weight loss. Medical history was notable for hypertension being treated with olmesartan. Initially, investigation for all potential infectious causes and celiac disease was negative. Both upper and lower endoscopy was performed with duodenal biopsies revealing total villous atrophy and colonic biopsies showing lymphocytic colitis. In the presence of negative serology for celiac disease and after a thorough review of the patient's medications, olmesartan inducedenteropathy was the most possible diagnosis. Olmesartan was discontinued and the symptoms rapidly resolved. A follow-up done a few months later showed no recurrence of the symptoms. In olmesartanassociated enteropathy, discontinuation of olmesartan results in immediate clinical recovery. Although rare, it is considered an emerging and underdiagnosed enteropathy. This case report illustrates the need for a thorough medication history evaluation and regular review during workup. We aim to increase the awareness of olmesartan-induced enteropathy among clinicians and gastroenterologists. We hope it will add to the current literature and help to understand this rare phenomenon in order to avoid unnecessary testing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

Sotiropoulos

Sakka

Διαμαντοπούλου

et al. 2021

Cureus

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An unusual cause of diarrhoea: case report and literature review of olmesartan-associated enteropathy

Mauloni¹,

Capuani²,

Paone³

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Olmesartan is an angiotensin II receptor blocker, approved in 2002 by the Food and Drug Administration for the treatment of hypertension. During chronic therapy with olmesartan, sprue-like enteropathy can occur, being mainly characterised by non-bloody diarrhoea, weight loss and variable degrees of duodenal mucosal damage, which resolved after withdrawal of olmesartan. We hereby report the case of a 77-year-old, poli-treated male patient with a 3-month history of diarrhoea, vomiting and weight loss, associated with severe intestinal villous atrophy and lymphocytic infiltration of gastric and colonic mucosa. After extensive investigations aimed at excluding other possible causes of chronic diarrhoea, a diagnosis of olmesartan-associated enteropathy was made, which was later confirmed by clinical improvement after the discontinuation of the drug. Repeated endoscopy 8 months later showed complete healing of duodenal mucosa with normal villous architecture. Villous atrophy and lymphocytic infiltration of duodenal mucosa are the most described pathologic finding, but several cases of gastric and colonic involvement have also been reported. We, therefore, reviewed the available literature, focussing on the extent of mucosal damage throughout the whole intestine and on its possible causative factors.

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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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Olmesartan-Induced Spruelike Enteropathy: An Emerging Cause of Small Bowel Injury

Cited by 4 publications

References 16 publications

Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

An unusual cause of diarrhoea: case report and literature review of olmesartan-associated enteropathy

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

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