Olmesartan-Induced Collagenous Gastritis, Duodenitis, and Colitis

Taylor, Robert G.; Chapman, Casey

doi:10.14309/00000434-201410002-00875

Cited by 1 publication

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“…Olmesartan‐induced enteropathy has been described in numerous studies, 1–12 with cases often demonstrating duodenal villous atrophy and intra‐epithelial lymphocytosis, mimicking coeliac disease. Collagenous sprue is also well‐documented in this setting 2–4,11 . The mechanism of ARB‐induced enteropathy remains unknown, but the several‐year duration of drug exposure prior to enteropathy in many cases suggests a form of drug‐induced, cell‐mediated damage as opposed to a type I hypersensitivity reaction 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Olmesartan‐induced enteropathy has been described in numerous studies, 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 with cases often demonstrating duodenal villous atrophy and intra‐epithelial lymphocytosis, mimicking coeliac disease. Collagenous sprue is also well‐documented in this setting.…”

Section: Discussionmentioning

confidence: 99%

“…Collagenous sprue is also well‐documented in this setting. 2 , 3 , 4 , 11 The mechanism of ARB‐induced enteropathy remains unknown, but the several‐year duration of drug exposure prior to enteropathy in many cases suggests a form of drug‐induced, cell‐mediated damage as opposed to a type I hypersensitivity reaction. 9 Inhibition of transforming growth factor (TGF)‐β by ARBs, leading to altered immune homeostasis in the gut, and increased activation of type II angiotensin receptors, resulting in enterocyte apoptosis, have been proposed as possible mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…[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%

“…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%

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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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Section: Discussionmentioning

confidence: 99%