Olmesartan-Induced Sprue Like Enteropathy

Abstract

Chronic diarrhoea is a common clinical problem in gastroenterology practice and often it is difficult to diagnose the cause. Villous atrophy is not specific and the rarer possibility of drug-induced enteritis should always be considered. Olmesartan has recently been described as a cause of drug-induced enteropathy characterized by chronic diarrhoea and varying degrees of duodenal mucosa atrophy resembling celiac disease.We describe two cases of sprue-like enteropathy in patients treated with olmesartan for arterial hypertension several years before the onset of symptoms. Patients presented severe diarrhoea and significant weight loss, and both had histological evidence of intestinal villous atrophy. The clinical signs completely resolved after drug withdrawal.Olmesartan-induced enteropathy is a new clinical entity that must be included in the differential diagnosis of villous atrophy with negative celiac serology. The clinical and histological alterations easily and completely resolve after drug discontinuation, restoring quality of life to patients and avoiding unnecessary investigation.

Olmesartan-associated severe gastritis and enteropathy

“…Although the pathophysiology of olmesartan-associated enteropathy is unknown, it has been suggested there may be a cell-mediated immune response that damages the small intestinal brush border 2–6. Accordingly, in some studies, it has been found that people with autoimmune diseases have a higher predisposition 7 8. Severe chronic non-bloody diarrhoea and weight loss are the commonly reported symptoms.…”

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.…”

“…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.…”

“…Carneiro et al 33 report on a case diagnosed with systemic sclerosis during the work-up for sprue-like enteropathy associated with olmesartan. The association with autoimmune diseases has been reported in several other studies.…”