Olmesartan-associated sprue-like enteropathy: a systematic review with emphasis on histopathology

Burbure, N.; Lebwohl, Benjamin; Argüelles-Grande, Carolina; Green, Peter H. R.; Bhagat, Govind; Lagana, Stephen M.

doi:10.1016/j.humpath.2015.12.001

Cited by 118 publications

(66 citation statements)

References 32 publications

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“…Under‐reporting the severity of mucosal injury in follow‐up biopsies is concerning for patients and treating physicians, but in this study was rectified by re‐cutting biopsies with poorly orientated tissue sections. A further limitation of our findings might be that we did not consider potential drug‐induced enteropathy to occur in our study subjects, for example subjects using Olmesartan, proton pump inhibitors, nonsteroidal anti‐inflammatory drugs or selective serotonin reuptake inhibitors …”

Section: Discussionmentioning

confidence: 99%

Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet

et al. 2020

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Summary Background The prevalence and severity of duodenal injury in coeliac disease patients controlled on a gluten‐free diet is unclear. Aims To use quantitative histology to assess duodenal injury in treated coeliac disease. Methods Quantitative histology in pre‐treatment duodenal biopsies collected in clinical trials assessing an investigational immunotherapy for coeliac disease was analysed. Morphometric readings were converted to Marsh classifications. Results Ninety‐three patients had duodenal biopsies. For well‐oriented sections of second part biopsies, six (6%) patients were classified as Marsh 0 or 1, 30 (33%) as Marsh 2 and 56 (60%) as Marsh 3a or 3b. In second part biopsies from 78 seronegative patients on gluten‐free diet >2 years, 27 (35%) were Marsh 2 and 45 (58%) were Marsh 3a or 3b. Distal compared to proximal duodenal biopsies had significantly higher villus height to crypt depth ratios (median, third part: 2.1 vs bulb: 1.4; P < 0.0001) and higher intraepithelial lymphocyte density (44 vs 30; P = 0.0002). The sum of paired villus height and adjacent crypt depth measurements was correlated strongly with villus height (rs = 0.82, P < 10−10). At least one biopsy was graded Marsh 3a or worse in all 26 patients who had serial biopsies from the bulb, first, second and third part, but was overlooked in 20 patients by subjective histology. Conclusions Quantitative histology in well‐oriented biopsy sections reveals villus atrophy in the majority of patients with coeliac disease who appear well controlled on gluten‐free diet. Standardisation of biopsy collection, processing and evaluation could substantially improve the value of follow‐up biopsies in coeliac disease.

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Section: Discussionmentioning

confidence: 99%

Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet

et al. 2020

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“…Several recent studies have reported olmesartan-induced sprue-like enteropathy 1234. A systematic review of 54 cases of olmesartan-induced sprue-like enteropathy showed that 64% patients were human leukocyte antigen (HLA) DQ2/DQ8 positive, whereas the incidence of HLA DQ2/DQ8-positive individuals is 40% among the general population; therefore, the involvement of the HLA system in this disease cannot be ruled out 3.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review of 54 cases of olmesartan-induced sprue-like enteropathy showed that 64% patients were human leukocyte antigen (HLA) DQ2/DQ8 positive, whereas the incidence of HLA DQ2/DQ8-positive individuals is 40% among the general population; therefore, the involvement of the HLA system in this disease cannot be ruled out 3. Interestingly, similar to patients with celiac sprue, some patients with sprue-like enteropathy show a subepithelial collagen band, with one-third having lymphocytic gastritis 23…”

Section: Discussionmentioning

confidence: 99%

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Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers

et al. 2017

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Recent studies have identified sprue-like illness associated with the use of the antihypertensive agent olmesartan medoxomil. However, whether this condition is specific to the use of olmesartan or is associated with the use of drugs belonging to the class of “sartans” remains to be clarified. A 45-year-old woman with chronic kidney disease along with hypothyroidism and hypertension presented with chronic diarrhea and significant weight loss. Endoscopy of the upper gastrointestinal tract showed scalloping and grooving of the duodenum, and histopathological examination showed subtotal villous atrophy. She was on telmisartan for hypertension, which was discontinued. Subsequently, diarrhea ameliorated dramatically, and she regained weight. To our knowledge, this is the first study to report telmisartan-associated sprue-like enteropathy. Further, we have reviewed the cases of patients with sprue-like enteropathy caused by valsartan, irbesartan, and eprosartan.

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“…NSAID-induced enteropathy is well described [59]. Recently, an olmesartan-related enteropathy has been described [60], and the genetic basis for an enteropathy related to defective prostaglandin transport has been reported [61]. Although a number of enteropathies look superficially similar to EE, there are recognisable differences.…”

Section: Contrasting Tropical With Other Enteropathiesmentioning

confidence: 99%

Tropical Enteropathies

Louis-Auguste

Kelly

2017

Curr Gastroenterol Rep

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Purpose of ReviewThe term ‘tropical enteropathy’ originated in observations in the 1960s that small intestinal morphology and function differed in the tropics from the norms found in temperate climates. It was subsequently shown that this enteropathy is more closely related to environmental conditions than latitude, and it was re-labelled ‘environmental enteropathy’. It is now recognised that environmental enteropathy (also now called environmental enteric dysfunction) has implications for the health and linear growth of children in low- and middle-income countries, and it may underlie poor responses to oral vaccination in these countries. The purpose of this review is to define and clarify this enteropathy despite the confusing terminology it has attracted and to contrast it with other enteropathic states.Recent FindingsRecent work has begun to demonstrate the nature of the mucosal lesion and the relationship with microbial translocation which is currently thought to link a failure of mucosal barrier function and the cascade of systemic inflammation which inhibits growth. The evidence is still correlative rather than definitive, but derives some additional support from animal models. There are some common features between environmental enteropathy and other enteropathies, but there are important differences also. The mechanism of the link between enteropathy and vaccine failure is not understood, and neither is it clear how the more severe form of enteropathy, which we refer to as malnutrition enteropathy, is driven by nutrient depletion and intestinal infection.SummaryTropical enteropathies form a group of disorders which include environmental and nutritional enteropathies. The long-term health implications of these disorders for health in low-income countries are just being explored, but the scale of their effects is very large, with millions of people affected.

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Olmesartan-associated sprue-like enteropathy: a systematic review with emphasis on histopathology

Cited by 118 publications

References 32 publications

Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet

Baseline quantitative histology in therapeutics trials reveals villus atrophy in most patients with coeliac disease who appear well controlled on gluten‐free diet

Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers

Tropical Enteropathies

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