SIRS, We read the article by Ianiro et al.1 reviewing recent knowledge about sprue-like enteropathy associated with olmesartan with great interest. Almost all of the 54 patients with diarrhoea and weight loss had duodenal villous atrophy, and signs and symptoms disappeared after discontinuation of the drug. A thickened subepithelial collagen layer in the duodenum was identified in one-third of patients. We have observed a similar case of collagenous ileitis, colitis and gastritis associated with use of telmisartan. A 71-year old woman complained of diarrhoea and weight loss while taking 40 mg of telmisartan (Tolura Krka, d.d., Novo mesto, Slovenia) for arterial hypertension for 2 months. Worsening of diarrhoea led to renal insufficiency and forced her to be admitted to hospital; serology for coeliac disease and all tests for infectious causes of diarrhoea were negative.Colonoscopy showed reduced villous pattern in the terminal ileum, and focally erythematous colonic mucosa with exudate. Histology demonstrated severe villous atrophy, intraepithelial lymphocytosis, subepithelial deposits of hyaline material and severe inflammatory infiltration of lamina propria mucosae in the terminal ileum (Figure 1). A similar subepithelial hyalin band was identified in colonic samples. Upper endoscopy was normal including duodenal villous pattern. Duodenal biopsy was also normal, but subepithelial collagen deposits were detected in gastric samples.Telmisartan was withdrawn; neither a gluten-free diet nor corticosteroid therapy was introduced. Suspension of telmisartan relieved all signs and symptoms and histology of terminal ileum and the colon was normalised within an interval of 7 months.Telmisartan and olmesartan are the latest angiotensin receptor blockers with the longest biological half-life (24 and 16 hours respectively).To our knowledge, we are presenting the first case of collagenous ileitis, colitis and gastritis closely associated with telmisartan use. The question thus arises as to whether the risk of sprue-like enteropathy could possibly be associated with this class of drug as a whole. AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 300 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via

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