Olmesartan-Induced Enteropathy: An Unusual Cause of Villous Atrophy

Abstract

We report a case of a 63-year-old-man presenting with chronic diarrhea and weight loss while on olmesartan treatment for hypertension. Investigation showed multiple nutritional deficiencies associated with diffuse intestinal villous atrophy. Serologies for celiac disease were negative and other causes of villous atrophy were excluded. Olmesartan as a precipitant agent was suspected and withdrawn. Clinical improvement occurred in days with no need for other therapeutic measures. Follow-up at three months showed clinical remission and almost complete recovery of intestinal atrophy.Olmesartan is an angiotensin receptor blocker commonly prescribed for the management of hypertension. Spruelike enteropathy associated with this drug is a recently described entity with few cases reported. It presents with chronic diarrhea and intestinal villous atrophy and should be included in its differential diagnosis. This case intends to alert clinicians for the possibility of this event in a patient on treatment with this drug.

Olmesartan-Induced Spruelike Enteropathy: An Emerging Cause of Small Bowel Injury

“…Endoscopic biopsy is an important diagnostic investigation. Pathologic examination of biopsy specimens commonly shows total or partial duodenal villous atrophy, mucosal granulocytic infiltration, and a thickened subepithelial collagen layer [9,12,14]. Conversely, a remarkable histologic variation may exist in these patients.…”

Sprue-Like Enteropathy Associated with Olmesartan: An Unrecognized Emerging Drug-Induced Enteropathy?

“…We read with great interest the case reports by da Silva et al 1 , Carneiro et al 2 and Eusébio et al 3 published in the late issue of GE Portuguese Journal of Gastroenterology .…”

Sprue-Like Enteropathy Associated With Olmesartan: A New Kid on the Enteropathy Block

“…In this issue of GE Portuguese Journal of Gastroenterology , case reports by da Silva et al 32 , Carneiro et al 33 and Eusébio et al 34 , highlight the importance of considering sprue-like enteropathy associated with olmesartan when approaching a patient with seronegative villous atrophy and provide further information to aid in diagnosis of this emergent disease.…”

“…Eusébio et al 34 identify a unique finding of elevated transaminases in a case of olmesartan associated enteropathy. They propose that this may be due to the same mechanism behind the hypertransaminasemia seen in CD.…”

“…In the four cases reported in this issue, symptoms resolved within 48 h to one week of discontinuation of olmesartan. 32 , 33 , 34 Trialing a patient off of a medication early on in the evaluation of seronegative villous atrophy could therefore provide both a rapid and cost-effective diagnosis. It is our practice that following olmesartan withdrawal, we try to understand the primary indication for olmesartan therapy and reassess the need for alternative medications together with the patient's primary care physician.…”