Severe spruelike enteropathy and collagenous colitis caused by olmesartan

Kaneko, Shiho; Matsumoto, Kana; Mizuta, Yasuko; Shiratori, Shoya; Kishi, Kazuma; Nakamura, Akihisa; Yagisawa, Masataka; Ehira, Nobuyuki; Uebayashi, Minoru; Kobayashi, Hiroya

doi:10.1186/s12876-021-01926-y

Cited by 9 publications

(22 citation statements)

References 36 publications

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“…patients, 11,17,19,21,30,32,43,45,54,55,57,62,78,88,97,101 and in 20 patients the presence of a thickened sub-epithelial collagen band was repo rted. 11,17,24,25,30,47,48,57,58,62,65,66,69,72,78,94,102 Figure 3 shows the typical histopathological features in the duodenum of a patient affected by OAE at baseline and after ARBs suspension.…”

Section: Duodenal Histopathological 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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Section: Duodenal Histopathological 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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“… 1 The number of cases of olmesartan‐related sprue‐like enteropathy is increasingly reported in Japan. 2 , 3 , 4 , 5 Herein, we describe a case of the olmesartan‐related sprue‐like disease in which improvement in villous atrophy was confirmed by small bowel capsule endoscopy (CE). In this case, gastric mucosal atrophy could be visualized by esophagogastroduodenoscopy.…”

Section: Introductionmentioning

confidence: 99%

“…The symptom onset often occurs from several months to years after starting this medication 1 . The number of cases of olmesartan‐related sprue‐like enteropathy is increasingly reported in Japan 2–5 . Herein, we describe a case of the olmesartan‐related sprue‐like disease in which improvement in villous atrophy was confirmed by small bowel capsule endoscopy (CE).…”

Section: Introductionmentioning

confidence: 99%

A case report of olmesartan‐associated sprue‐like enteropathy: Diagnosis and healing confirmed by capsule endoscopy

Yamaguchi

Miwa

Murakami³

et al. 2022

DEN Open

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Herein, we describe a case of olmesartan‐related sprue‐like enteropathy in which improvement in villous atrophy was confirmed by small‐bowel capsule endoscopy (CE). We successfully treated a 66‐year‐old man with a chief complaint of loose diarrhea. The patient had persistent watery diarrhea 10 times a day and experienced a weight loss of 9 kg in 3 months. An abdominal computed tomography scan showed fluid retention in the small intestine. Blood test results revealed no inflammatory reaction. Esophagogastroduodenoscopy detected villous atrophy in the stomach and duodenum. Moreover, small‐bowel CE showed villous atrophy in about two‐thirds of the small intestine. Based on other examinations, hyperthyroidism, intestinal tuberculosis, intestinal amyloidosis, and intestinal malignant lymphoma were ruled out. Therefore, the patient was suspected of having an olmesartan‐related sprue‐like disease. Early after discontinuation of medication, diarrhea symptoms improved, and a repeat CE indicated improvements in small intestinal villous atrophy. Since the patient had been administered olmesartan for a long time and CE showed villous atrophy throughout the small bowel, we suspected him of having the olmesartan‐associated sprue‐like disease. The findings of gastric mucosa atrophy on esophagogastroduodenoscopy may lead to an early diagnosis of this disease. Olmesartan‐related sprue‐like enteropathy should be considered as a differential diagnosis in patients with chronic severe watery diarrhea.

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“…Olmesartan-induced enteropathy has been increasingly reported in the literature since 2012; the most commonly reported histologies are villous atrophy and intraepithelial lymphocytosis [ 2 ]. In most of the previously reported cases, the discontinuation of olmesartan improved patient presentations [ 2 - 9 ].…”

Section: Introductionmentioning

confidence: 99%

Olmesartan-Induced Ischemic Enteritis Complicated With Bowel Perforation: A Case Report and Literature Review

Alexander¹,

Abdelazeem²,

Alnounou³

2023

Cureus

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Olmesartan is a relatively new angiotensin receptor blocker used widely to control hypertension. Cases have been reported previously of enteropathy induced by olmesartan. Here, the authors report a case of olmesartan-induced ischemic enteritis complicated by bowel perforation. A 52-year-old male patient, during the treatment with olmesartan, developed severe abdominal pain of five-day duration. He underwent exploratory laparotomy for bowel perforation and surgical resection of the ischemic bowel segment. On a two-month follow-up after the discontinuation of olmesartan and the emergency surgery, the patient was symptom-free and functioning well. This rare report focuses on ischemic enteritis associated with olmesartan, describes the symptoms, and records the progression of this side effect and the corresponding treatment. Our case aims to raise awareness amongst physicians about the possibility of this severe complication and to point out that more research is still needed on its pathophysiology to better understand this drug.

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Severe spruelike enteropathy and collagenous colitis caused by olmesartan

Cited by 9 publications

References 36 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

A case report of olmesartan‐associated sprue‐like enteropathy: Diagnosis and healing confirmed by capsule endoscopy

Olmesartan-Induced Ischemic Enteritis Complicated With Bowel Perforation: A Case Report and Literature Review

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