Severe Sprue-Like Enteropathy and Colitis due to Olmesartan: Lessons Learned From a Rare Entity

Bashari, Daniel R.

doi:10.14740/gr1301

Cited by 7 publications

(22 citation statements)

References 17 publications

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“…We have thus performed a systematic literature search in Medline up to October 2020, using the following strings: “olmesartan enteropathy”, “olmesartan villous atrophy”, “olmesartan chronic diarrhoea”, “olmesartan malabsorption”, including only the 40 studies reporting gastric or colonic histopathologic evaluation on biopsies in addition to duodenal ones in humans were considered. Only English articles reporting data of OAE on humans were considered and summarised in Table 1 [1,8–46]. First, we found that villous atrophy was present in 93.5% of cases (61% villous atrophy, 32.4% PVA), confirming previously nonsystematic reported data [6].…”

Section: Discussionsupporting

confidence: 82%

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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Section: Discussionsupporting

confidence: 82%

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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“…However, no follow-up colon biopsy was performed in all three cases. Bashari DR et al also reported a case of olmesartan-associated spruelike enteropathy complicated with collagenous colitis, but they did not report a follow-up CS [15]. Ebrahim VS et al reported that collagenous colitis was observed in 2 of 3 cases, and in 1 case, a reexamination was performed 4 months after the withdrawal of olmesartan, and it is mentioned that histopathological improvement was observed [16].…”

Section: Discussionmentioning

confidence: 99%

“…olmesartan discontinuation [15]. Some patients with collagenous colitis showed a typical histology but had no symptoms [18].…”

Section: Abbreviationsmentioning

confidence: 99%

Severe spruelike enteropathy and collagenous colitis caused by olmesartan

et al. 2021

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Background Olmesartan, which is an angiotensin II receptor blocker, reportedly causes spruelike enteropathy, with intestinal villous atrophy as its typical histopathological finding. Interestingly, collagenous and/or lymphocytic gastritis and colitis occur in some patients. We report the case of a 73-year-old Japanese man with a 2-month clinical history of severe diarrhea and weight loss. There were few reports in which spruelike enteropathy and collagenous colitis were both observed and could be followed up. Case presentation We report a case of a 73-year-old man with a 2-month clinical history of severe diarrhea and weight loss. He had taken olmesartan for hypertension treatment for 5 years. Endoscopic examination with biopsies revealed intestinal villous atrophy and collagenous colitis. Suspecting enteropathy caused by olmesartan, which was discontinued on admission because of hypotension, we continued to stop the drug. Within 3 weeks after olmesartan discontinuation, his clinical symptoms improved. After 3 months, follow-up endoscopy showed improvement of villous atrophy but not of the thickened collagen band of the colon. However, the mucosa normalized after 6 months, histologically confirming that the preexistent pathology was finally resolved. Conclusions This report presents a case in which spruelike enteropathy and collagenous colitis were both observed and could be followed up. In unexplained cases of diarrhea, medication history should be reconfirmed and this disease should be considered a differential diagnosis.

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“…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%

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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Severe Sprue-Like Enteropathy and Colitis due to Olmesartan: Lessons Learned From a Rare Entity

Cited by 7 publications

References 17 publications

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

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

Severe spruelike enteropathy and collagenous colitis caused by olmesartan

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

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