Villous Atrophy and Negative Celiac Serology: A Diagnostic and Therapeutic Dilemma

Abstract

The role of medications in the development of VA and the optimal dose and length of immunosuppression for patients with US should be investigated further.

Olmesartan-associated enteropathy: results of a national survey

“…Clinical, biological and histological manifestations All 32 patients (100%) had diarrhoea, with a median number of 8 liquid stools per day [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Twenty-four patients (75%) had abdominal pain, which was rarely severe (n = 3).…”

“…15 It has also been suggested that Olmesartan may account for a significant proportion of noncoeliac enteropathy, as reported in a series of 72 adult patients with villous atrophy and negative coeliac disease serology. 16 Sixteen of them were found to be treated with olmesartan, 15 of whom improved after olmesartan withdrawal. Several other cases have been reported.…”

“…The median cumulative hospital stay was 29 days . Four patients required intensive care (12 days [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]). Seven patients required enteral nutrition (30 days ) and 10 required parenteral nutrition (29 days ).…”

Olmesartan-Associated Enteropathy

“…Th e pathogenesis of olmesartan-associated enteropathy is not fully understood, but is thought to involve a cell-mediated immune response causing damage to the intestinal brush border (2,8). In Rubio-Tapia's initial study, 15 of 22 patients were found to be positive for HLA-DQ2 or HLA-DQ8 (1).…”

“…All were on olmesartan, and upon discontinuing this agent, their symptoms resolved or signifi cantly improved with histologic recovery. Other reports of olmesartan-associated enteropathy have since appeared in the gastroenterology literature (2)(3)(4). Patients typically present with severe chronic diarrhea accompanied by abdominal bloating and cramping, usually with weight loss, nausea, and vomiting, and frequently require hospitalization for intravenous hydration.…”