Significant Weight Loss in a Patient Taking Olmesartan: An Unusual Case Report

Abstract

Objective: Olmesartan-induced enteropathy consists a syndrome that mimics celiac disease both clinically and histologically. Cases of this entity have sporadically been reported since 2012 and are usually characterized by severe diarrhea and malabsorption, followed by significant weight loss. Case Report: Herein, we report an uncommon case of this syndrome, where weight loss preceded several months the onset of gastrointestinal symptoms. Discussion and Conclusion: Physicians should be aware of unexplained weight loss in patients taking olmesartan, as prompt discontinuation of the drug may prevent the deleterious consequences of malabsorption.

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

“…Overall, we included 97 papers in the present review. Ninety‐four were case reports or case series of enteropathy due to ARBs (86 case reports or case series with less than five patients 13–98 and eight case series with five or more patients 5,11,99–104 ) corresponding to a total of 183 patients (101 F, mean age at diagnosis 69 ± 10 years) published between 2012 and 2023, with most cases being reported in Europe (93 cases) 11,13,17,18,20,21,23,24,26,27,30–34,40,44,45,50,51,55–57,61–64,67,68,70,73,75,77,80,83–85,89–92,94–96,98,100,101,103,104 and North America (67 cases) 5,14,16,22,25,28,29,36–38,41–43,46,47,52–54,58,60,66,69,71,72,86,93,97,102 . Some cases were also reported in India (9),…”

“…p < 0.05 were considered statistically significant. Ninety-four were case reports or case series of enteropathy due to ARBs (86 case reports or case series with less than five patients and eight case series with five or more patients 5,11,[99][100][101][102][103][104] ) corresponding to a total of 183 patients (101 F, mean age at diagnosis 69 ± 10 years) published between 2012 and 2023, with most cases being reported in Europe (93 cases) 11,13,17,18,20,21,23,24,26,27,[30][31][32][33][34]40,44,45,50,51,[55][56][57][61][62][63][64]67,68,70,73,75,77,80,[83][84][85][89][90][91]…”

“…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]…”

Uma causa rara de diarreia: efeito pouco frequente de um medicamento comum

“…As formas mais frequentes de apresentação são a diarreia crónica, a perda ponderal não intencionada e o desconforto abdominal. [4][5]13 Sem características analíticas patognomónicas destaca-se pelos achados histológicos no estudo endoscópico ao nível do intestino delgado, com achatamento, ou mesmo atrofia, das vilosidades duodenais, assemelhando-se aos da doença celíaca. Distingue-se desta última pela ausência de marcadores sorológicos (anticorpos antitransglutaminase e endomísio) e inexistência de resposta a uma dieta sem glúten.…”

“…2 Existe uma variedade de classes farmacológicas que reduzem a pressão arterial através de diferentes mecanismos de ação, salientando-se a classe dos antagonistas do recetor da angiotensina II (ARA), comummente utilizados na prática clínica devido ao seu distinto perfil de segurança e efeito anti-hipertensivo. 4 Os ARA ligam-se ao recetor da angiotensina II tipo 1, inibindo, assim, o sistema renina-angiotensina e a sua cascata de efeitos de contração arteriolar e relatosdecaso retenção de sódio. [5][6][7] Atualmente existem oito ARA de uso clínico em Portugal -olmesartan, losartan, valsartan, irbesartan, eprosartan, candesartan, telmisartan, azilsartan medoxomilo -que possuem entre si semelhante estrutura e atividade química, mas ligeiras diferenças ao nível da sua farmacocinética.…”