Olmesartan-associated severe gastritis and enteropathy

Shenbagaraj, Lavanya; Swift, G. L.

doi:10.1136/bcr-2018-226133

Cited by 14 publications

(29 citation statements)

References 9 publications

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“…Previous reports have described olmesartan associated with severe enteropathy as well as gastritis. 9 – 11 Olmesartan-associated gastritis was an initial consideration for this patient, but discontinuation of olmesartan did not resolve her gastritis.…”

Section: Discussionmentioning

confidence: 98%

Autoimmune Gastritis Treated With Mycophenolate Mofetil

et al. 2020

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Autoimmune gastritis is an inflammatory condition of the gastric mucosa. We report a 64-year-old woman with chronic abdominal pain of 3-year duration. Endoscopic and histologic evaluation revealed autoimmune pangastritis. The gastritis was partially responsive to steroids but attempts to taper failed, and the patient had no relief from mercaptopurine, adalimumab, budesonide, or hydroxychloroquine. The patient was treated with mycophenolate mofetil which resulted in resolution of symptoms. Endoscopic and histologic examination after mycophenolate therapy showed near complete resolution of active inflammation. To the best of our knowledge, this is the first report of symptomatic autoimmune gastritis successfully treated by mycophenolate mofetil.

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Section: Discussionmentioning

confidence: 98%

Autoimmune Gastritis Treated With Mycophenolate Mofetil

et al. 2020

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“…One of the proposed mechanisms involves a cellmediated immune response that damages the small intestinal brush border [2][3]. In addition, it is thought that the ARB class of drugs has an inhibitory action of transforming growth factor-beta (TGF-β), which is important for the gut homeostasis and apoptosis of enterocytes due to disproportionate activation of type 2 angiotensin II (AT2) receptors after blockage of type 1 angiotensin II receptors (AT1) [2,[4][5][6]8].…”

Section: Discussionmentioning

confidence: 99%

“…Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms, including chronic severe non-bloody diarrhea and significant weight loss that is unresponsive to a glutenfree diet [1][2][5][6]. The time between olmesartan exposure and the onset of symptoms usually ranges from few months to five years [1].…”

Section: Introductionmentioning

confidence: 99%

“…Laboratory investigation commonly reveals findings consistent with a severe malabsorption process like anemia, electrolyte imbalance (hypokalemia and hypocalcemia), and hypoalbuminemia [1]. Typically, celiac serology (including anti-transglutaminase, anti-gliadin, and anti-endomysial antibodies) is always negative, antinuclear antibodies may be positive, and the majority of patients may have either HLA-DQ2 or DQ8 haplotypes [1,[4][5]. Histopathological findings include total or partial duodenal villous atrophy, mucosal granulocytic infiltration, and a thickened subepithelial collagen layer [1,6].…”

Section: Introductionmentioning

confidence: 99%

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Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

Sotiropoulos

Sakka

Διαμαντοπούλου

et al. 2021

Cureus

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Olmesartan, an angiotensin II receptor blocker indicated in the treatment of hypertension, has been associated with a seronegative sprue-like enteropathy that should be considered in the differential diagnosis of patients with unexplained chronic diarrhoea. It typically presents with severe chronic diarrhoea, considerable weight loss, and villous atrophy on biopsy and may be difficult to recognize because of its clinical and histological similarities to other clinical entities. Practically, discontinuation of the drug leads to dramatic recovery of the symptoms. We report a 76-year-old Caucasian female who was admitted to our hospital with complaints of chronic diarrhea and significant weight loss. Medical history was notable for hypertension being treated with olmesartan. Initially, investigation for all potential infectious causes and celiac disease was negative. Both upper and lower endoscopy was performed with duodenal biopsies revealing total villous atrophy and colonic biopsies showing lymphocytic colitis. In the presence of negative serology for celiac disease and after a thorough review of the patient's medications, olmesartan inducedenteropathy was the most possible diagnosis. Olmesartan was discontinued and the symptoms rapidly resolved. A follow-up done a few months later showed no recurrence of the symptoms. In olmesartanassociated enteropathy, discontinuation of olmesartan results in immediate clinical recovery. Although rare, it is considered an emerging and underdiagnosed enteropathy. This case report illustrates the need for a thorough medication history evaluation and regular review during workup. We aim to increase the awareness of olmesartan-induced enteropathy among clinicians and gastroenterologists. We hope it will add to the current literature and help to understand this rare phenomenon in order to avoid unnecessary testing.

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“…[1][2][3] Histological changes have also been described in the stomachs of patients on ARBs, but the spectrum of morphological features has not been closely examined. 2,[4][5][6][7] Our multi-institutional study aims to describe the histological features of ARB-induced gastric injury and examine the effect of drug cessation on these changes. Awareness of these findings will allow pathologists to suggest ARB therapy as a potential aetiology of gastritis in these patients.…”

Section: Introductionmentioning

confidence: 99%

The histological spectrum of ARB‐induced gastritis

et al. 2022

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Aims Olmesartan, an angiotensin receptor blocker (ARB) used for hypertension management, is known to cause a sprue‐like enteropathy in a subset of patients. Rare cases of gastritis occurring with ARB use have also been reported, but the histological features of ARB‐induced gastritis and the response to drug cessation have not been examined in a dedicated case‐series. Methods and results Cases of suspected ARB‐induced gastritis were identified from the pathology archives of four institutions. Haematoxylin and eosin (H&E) slides from gastric biopsies were reviewed. Fifteen patients (14 female, one male) were identified. The most common presenting symptoms were diarrhoea (10) and weight loss (six). Gastric biopsies commonly showed a full‐thickness active chronic gastritis with surface epithelial injury involving the antrum and body. Glandular atrophy, intra‐epithelial lymphocytosis and/or subepithelial collagen thickening were also present in some cases. Duodenal involvement, including villous atrophy, intra‐epithelial lymphocytosis and/or collagenous sprue, was identified in 11 of 13 cases with concurrent duodenal biopsies. Following drug cessation, symptomatic improvement occurred in all 11 cases for which follow‐up data were available. Histological resolution occurred in five of eight cases with follow‐up gastric biopsies, with improvement seen in the remaining three biopsies. Conclusion ARB‐induced gastritis typically presents as active chronic gastritis, frequently with associated surface epithelial injury. Glandular atrophy, intra‐epithelial lymphocytosis and/or subepithelial collagen thickening may also be present. These gastric changes can be seen without associated duodenal injury in rare cases, and they should alert the pathologist to the possibility of ARB‐induced injury. Drug cessation results in marked symptomatic and histological improvement.

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Olmesartan-associated severe gastritis and enteropathy

Cited by 14 publications

References 9 publications

Autoimmune Gastritis Treated With Mycophenolate Mofetil

Autoimmune Gastritis Treated With Mycophenolate Mofetil

Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea

The histological spectrum of ARB‐induced gastritis

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