Atrophic enteropathy refractory to a gluten-free diet: what should we consider?

Maldonado, Alicia Martín Lagos; Ruiz-Aragón, Fátima García-Consuegra; Mercader, Myriam Del Carmen Herrera

doi:10.17235/reed.2020.6361/2019

Cited by 5 publications

(19 citation statements)

References 4 publications

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“…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]…”

Section: Discussionmentioning

confidence: 99%

“…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]…”

Section: Distribution Of Mucosal Changes Throughout the Gi Tractmentioning

confidence: 99%

“…13,15,31,32,35,43,48,49,52,61,65,66,81,86 Among the 164 patients with VA, additional findings in the stomach or in the colon were present in 55 patients (30.1%). Of these 55 patients, 12 had pan-GI mucosal changes (gastric, small bowel and colonic involvement), 5,20,34,38,42,61,80,84,92,93 23 had evidence of gastric findings in addition to small bowel involvement 5,11,30,50,71,77,87,93,100,102 and 20 had colonic mucosal changes in addition to small bowel involvement. 5,16,21,26,29,36,48,52,60,62,70,91,93,[99][100]…”

Section: Distribution Of Mucosal Changes Throughout the Gi Tractmentioning

confidence: 99%

“…Gastric findings included chronic lymphocytic gastritis in eight patients, 5,17,34,38,42,80,84,92 although one had Helicobacter pylori infection, 5 three cases of collagenous gastritis 5,20,93 and one case of erosive gastritis. 61 Colonic findings included microscopic colitis in 10 patients (five lymphocytic colitis, 5,34,38,42,84,92 four collagenous colitis, 5,20,93 one unspecified microscopic colitis 80 ), one had ulceration of the proximal colon 42 and one had ulcerative ileitis. 61…”

Section: Patients With Pan-gastrointestinal Mucosal Changesmentioning

confidence: 99%

“…61 Colonic findings included microscopic colitis in 10 patients (five lymphocytic colitis, 5,34,38,42,84,92 four collagenous colitis, 5,20,93 one unspecified microscopic colitis 80 ), one had ulceration of the proximal colon 42 and one had ulcerative ileitis. 61…”

Section: Patients With Pan-gastrointestinal Mucosal Changesmentioning

confidence: 99%

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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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