Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review

Abstract

Small bowel villous atrophy due to immune-checkpoint inhibitors: report of two cases and literature review.

Focus on Immune Checkpoint Inhibitors-related Intestinal Inflammation: From Pathogenesis to Therapeutical Approach

“… 19 , 20 Interestingly, rare cases of new onset of celiac disease have been described, although its relationship with ICI treatment is not well demonstrated, and it is unclear whether the therapy with ICIs simply acts as a trigger factor that exacerbates an underlying subclinical enteropathy, leading to overt clinical manifestations, or induces celiac disease ex-novo, as it has been previously reported for other immune-related disorders. 21 , 22 In the majority of cases described, the gluten-free diet was sufficient to reverse the damage, and there was no therapeutic interruption. 22 …”

“… 21 , 22 In the majority of cases described, the gluten-free diet was sufficient to reverse the damage, and there was no therapeutic interruption. 22 …”

“…Notably, 2 main clinical phenotypes of small bowel involvement related to ICIs have been identified: the first is characterized by enteropathy with villous atrophy (VA), whether or not related to celiac disease, and the second is characterized by generally severe ulcerative enteritis, sometimes with massive gastrointestinal bleeding or perforation of the small intestine but without any mention of VA. 22 , 23 …”

“…Similar to the case with colonic involvement, the use of steroids, in particular, budesonide administered according to the Mayo Clinic open capsule schedule, and infliximab may be useful in treating the side effects of ICI related to small bowel involvement. 22 , 23 , 25 …”

Letter: The enigma of angiotensin receptor blocker‐associated enteropathy—Authors' reply

“…In conclusion, enteropathies due to olmesartan and, more rarely, to other ARBs still have an undefined pathogenesis. We believe that the study of intestinal microbiota in drug-related enteropathies with villous atrophy such as those due to ARBs or immune-checkpoint inhibitors 7,8 may represent a target for future studies and a potential candidate for personalised therapies.…”