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Gonakoti S, Khullar S, Rajkumar A. Olmesartan Associated Enteropathy: A Rare Underdiagnosed Cause of Diarrhea and Weight Loss. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:111-116. [PMID: 30683835 PMCID: PMC6364444 DOI: 10.12659/ajcr.913207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Olmesartan, an angiotensin receptor blockade class of antihypertensive medication has recently been associated with a seronegative sprue like enteropathy. Patients typically present with diarrhea and weight loss often prompting exhaustive diagnostic workup. Discontinuation of the drug leads to dramatic recovery and hence, physicians need to be aware of olmesartan associated enteropathy (OAE) in order to avoid unnecessary testing. CASE REPORT A 59-year-old Caucasian male was admitted to the hospital with complaints of intractable diarrhea, vomiting and considerable weight loss. Medical history was notable for hypertension being treated with olmesartan. Workup for all potential infectious causes and celiac disease was negative. Eventually, a colonoscopy was performed due to his persistent symptoms and biopsy revealed lymphocytic colitis. An upper endoscopy was also performed, and histopathology of the duodenum revealed total villous blunting. In light of negative serology for celiac disease and after a detailed review of the patient's medications, the possibility of olmesartan induced enteropathy was considered. Olmesartan was stopped and his symptoms resolved. A follow-up endoscopy done a few months later showed normal small bowel mucosa. CONCLUSIONS This case demonstrates the need for a thorough medication review by healthcare providers especially after a full workup for the patient's symptoms has already been performed. It also reiterates that having an awareness of rare side effects of common medications mitigates the need for extensive diagnostic testing.
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Affiliation(s)
- Sripriya Gonakoti
- Department of Internal Medicine, North East Ohio Medical University, Canton Medical Education Foundation, Canton, OH, U.S.A
| | - Sanjiv Khullar
- Department of Internal Medicine, North East Ohio Medical University, Rootstown, OH, U.S.A
| | - Aarthi Rajkumar
- Department of Internal Medicine, North East Ohio Medical University, Canton Medical Education Foundation, Canton, OH, U.S.A
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52
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You SC, Park H, Yoon D, Park S, Joung B, Park RW. Olmesartan is not associated with the risk of enteropathy: a Korean nationwide observational cohort study. Korean J Intern Med 2019; 34:90-98. [PMID: 29172402 PMCID: PMC6325440 DOI: 10.3904/kjim.2017.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/12/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND/AIMS Olmesartan, a widely used angiotensin II receptor blocker (ARB), has been linked to sprue-like enteropathy. No cases of olmesartan-associated enteropathy have been reported in Northeast Asia. We investigated the associations between olmesartan and other ARBs and the incidence of enteropathy in Korea. METHODS Our retrospective cohort study used data from the Korean National Health Insurance Service to identify 108,559 patients (58,186 females) who were initiated on angiotensin converting enzyme inhibitors (ACEis), olmesartan, or other ARBs between January 2005 and December 2012. The incidences of enteropathy were compared among drug groups. Changes in body weight were compared after propensity score matching of patients in the ACEis and olmesartan groups. RESULTS Among 108,559 patients, 31 patients were diagnosed with enteropathy. The incidences were 0.73, 0.24, and 0.37 per 1,000 persons, in the ACEis, olmesartan, and other ARBs groups, respectively. Adjusted rate ratios for enteropathy were: olmesartan, 0.33 (95% confidential interval [CI], 0.10 to 1.09; p = 0.070) and other ARBs, 0.34 (95% CI, 0.14 to 0.83; p = 0.017) compared to the ACEis group after adjustment for age, sex, income level, and various comorbidities. The post hoc analysis with matched cohorts revealed that the proportion of patients with significant weight loss did not differ between the ACEis and olmesartan groups. CONCLUSION Olmesartan was not associated with intestinal malabsorption or significant body weight loss in the general Korean population. Additional large-scale prospective studies of the relationship between olmesartan and the incidence of enteropathy in the Asian population are needed.
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Affiliation(s)
- Seng Chan You
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Hojun Park
- Department of Statistics, Ewha Womans University, Seoul, Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
| | - Sooyoung Park
- Department of Statistics, Ewha Womans University, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Rae Woong Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
- Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
- Correspondence to Rae Woong Park, M.D. Department of Biomedical Informatics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-4471 Fax: +82-31-219-4472 E-mail:
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53
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Shenbagaraj L, Swift G. Olmesartan-associated severe gastritis and enteropathy. BMJ Case Rep 2018; 11:e226133. [PMID: 30567227 PMCID: PMC6301752 DOI: 10.1136/bcr-2018-226133] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2018] [Indexed: 11/04/2022] Open
Abstract
Olmesartan is an angiotensin II receptor antagonist, used in the treatment of hypertension. We report a case of olmesartan-associated severe gastritis with enteropathy in a 74-year-old woman who presented with mainly upper gastrointestinal symptoms. There was significant endoscopic improvement in the mucosal inflammation on stopping the drug. Subsequent gastroscopy showed mucosal healing and normal gastric and duodenal mucosa. To our knowledge, this is the first case report of olmesartan-associated gastritis and enteropathy predominantly involving and affecting the whole of stomach with limited small bowel involvement.
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Affiliation(s)
| | - Gillian Swift
- Gastroenterology, University Hospital of Llandough, Cardiff, UK
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54
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Onteddu NK, Pulivarthi VSKK, Ginnavaram M, Kedika R. Olmesartan-induced enteropathy. BMJ Case Rep 2018; 2018:bcr-2018-224411. [PMID: 30279248 DOI: 10.1136/bcr-2018-224411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Olmesartan-induced enteropathy (OIE) typically presents with a constellation of signs and symptoms including chronic diarrhoea, weight loss and villous atrophy on biopsy. We describe a 68-year-old Caucasian woman with a history of hypothyroidism and hypertension who presented to our hospital with recurrent episodes of acute intermittent diarrhoea, nausea, vomiting, renal failure and 15 lbs weight loss. After an extensive workup, she was diagnosed with possible OIE. Cessation of the offending drug resulted in improvement of clinical symptoms and also hospital admissions for severe diarrhoea reinforcing the diagnosis of OIE. Among the adverse effects of drug therapy, diarrhoea is a relatively frequent adverse event accounting for about 7%. This report serves as an addition to existing literature and to increase the awareness of olmesartan-induced sprue-like enteropathy among the primary care physicians and gastroenterologists.
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Affiliation(s)
- Nirmal K Onteddu
- Internal Medicine, Texas Tech University Health Sciences Center at Permian Basin, Odessa, Texas, USA
| | | | - Mihira Ginnavaram
- Internal Medicine, Bhaskar Medical College, Ranga Reddy, Telangana, India
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55
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Melis C, Struyve M, Steelandt T, Neuville B, Deraedt K. Sprue-like enteropathy, do not forget olmesartan! Dig Liver Dis 2018; 50:621-624. [PMID: 29625908 DOI: 10.1016/j.dld.2018.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Affiliation(s)
- C Melis
- Department of Pathology, University Hospitals of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - M Struyve
- Department of Gastroenterology, Hepatology and Endoscopy, University Hospitals of Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
| | - T Steelandt
- Department of Pathology, University Hospitals of Leuven, Herestraat 49, Leuven, 3000, Belgium.
| | - B Neuville
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
| | - K Deraedt
- Department of Pathology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
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56
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Del Val A, García Campos M, García Morales N. Sprue-like enterophaty asscociated with valsartan. Med Clin (Barc) 2018; 150:329. [PMID: 29150128 DOI: 10.1016/j.medcli.2017.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/07/2017] [Accepted: 09/14/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Adolfo Del Val
- Sección de Gastroenterología, Hospital Universitario y Politécnico la Fe, Valencia, España.
| | - María García Campos
- Sección de Gastroenterología, Hospital Universitario y Politécnico la Fe, Valencia, España
| | - Natalia García Morales
- Sección de Gastroenterología, Hospital Universitario y Politécnico la Fe, Valencia, España
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57
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Uche-Anya EN, Green PHR, Genta RM, Lebwohl B. Regional Patterns of Olmesartan Prescription and the Prevalence of Duodenal Villous Atrophy Throughout the United States. Clin Gastroenterol Hepatol 2018; 16:584-585. [PMID: 28993259 DOI: 10.1016/j.cgh.2017.09.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/21/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Eugenia N Uche-Anya
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Peter H R Green
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Robert M Genta
- Miraca Life Sciences Research Institute, Irving, Texas; Baylor College of Medicine, Houston, Texas
| | - Benjamin Lebwohl
- Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
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58
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Kung VL, Liu TC, Ma C. Collagenous Enteritis is Unlikely a Form of Aggressive Celiac Disease Despite Sharing HLA-DQ2/DQ8 Genotypes. Am J Surg Pathol 2018; 42:545-552. [DOI: 10.1097/pas.0000000000001022] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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59
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Dong YH, Jin Y, Tsacogianis TN, He M, Hsieh PH, Gagne JJ. Use of olmesartan and enteropathy outcomes: a multi-database study. Aliment Pharmacol Ther 2018; 47:792-800. [PMID: 29359522 DOI: 10.1111/apt.14518] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/06/2017] [Accepted: 12/22/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Multiple case reports suggest that olmesartan may be linked to sprue-like enteropathy; however, few epidemiological studies have examined this association and results have been mixed. AIM To assess whether olmesartan is associated with a higher rate of enteropathy vs other angiotensin II receptor blockers (ARBs). METHODS We conducted a cohort study among ARB initiators in 5 US claims databases representing different health insurance programmes. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for enteropathy-related outcomes, including coeliac disease, malabsorption, concomitant diagnoses of diarrhoea and weight loss, and non-infectious enteropathy, comparing olmesartan initiators to initiators of other ARBs after propensity score (PS) matching. RESULTS We identified 1 928 469 eligible patients. The unadjusted incidence rates were 0.82, 1.41, 1.66 and 29.20 per 1000 person-years for coeliac disease, malabsorption, concomitant diagnoses of diarrhoea and weight loss, and non-infectious enteropathy respectively. HRs after PS matching comparing olmesartan to other ARBs were 1.21 (95% CI, 1.05-1.40), 1.00 (95% CI, 0.88-1.13), 1.22 (95% CI, 1.10-1.36) and 1.04 (95% CI, 1.01-1.07) for each outcome. HRs were larger for patients aged 65 years and older (eg for coeliac disease, 1.57 [95% CI, 1.20-2.05]), for patients receiving treatment for more than 1 year (1.62 [95% CI, 1.24-2.12]), and for patients receiving higher cumulative olmesartan doses (1.78 [95% CI, 1.33-2.37]). CONCLUSIONS This large-scale, multi-database study found a higher rate of enteropathy in olmesartan initiators as compared to initiators of other ARBs, although the absolute incidence rate was low in both groups.
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Affiliation(s)
- Y-H Dong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,Faculty of Pharmacy, School of Pharmaceutical Science, National Yang-Ming University, Taipei, Taiwan
| | - Y Jin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - T N Tsacogianis
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - M He
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - P-H Hsieh
- Department of Hepato-Gastroenterology, Chi Mei Medical Center, Tainan, Taiwan
| | - J J Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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60
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Malfertheiner P, Ripellino C, Cataldo N. Severe intestinal malabsorption associated with ACE inhibitor or angiotensin receptor blocker treatment. An observational cohort study in Germany and Italy. Pharmacoepidemiol Drug Saf 2018; 27:581-586. [PMID: 29457309 PMCID: PMC6001476 DOI: 10.1002/pds.4402] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/27/2017] [Accepted: 01/12/2018] [Indexed: 11/06/2022]
Abstract
Purpose The angiotensin II receptor blocker (ARB) olmesartan has been recently associated with sprue‐like enteropathy (SLE), a gastrointestinal condition characterized by intestinal malabsorption (IM) and severe diarrhea. Whether the increased risk of SLE is substance‐specific or a class effect involving all ARBs is uncertain. The aim of this study is to assess the risk of enteropathy associated with ARBs and angiotensin converting enzyme inhibitors (ACE‐i) by using data from large administrative and claim databases. Methods We obtained data from Italian local health‐care units and a large German claim database and included patients treated with olmesartan, other ARBs, and ACE‐i. In the absence of a specific diagnosis code for SLE, International Classification of Diseases codes for IM were used. Analysis implemented a Poisson regression with robust error variance procedure, which allowed accounting for different clusters (local health‐care units and countries) and correctly estimating the standard error for the relative risk of rare event occurrence. Results Patients were divided into 3 groups: olmesartan (25.591, 5.5%), other ARBs (104.901, 22.5%), and ACE‐i patients (334.951, 72.0%). Baseline characteristics were similar overall. The incidence of unspecified IM in ACE‐i patients was not different compared with that of olmesartan, whereas a higher rate ratio was observed when comparing ARB patients with the olmesartan group (RR: 2.50, 95% CI 1.21 to 5.19, P .01). When International Classification of Diseases codes for coeliac disease were included, no differences were observed. Conclusions We could not confirm previous findings of a higher risk of malabsorption in olmesartan‐only patients, and drug‐induced enteropathy should be considered the result of exposure to the class of ARBs rather than a specific drug‐related effect.
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Affiliation(s)
- Peter Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Otto-von-Guericke Universität, Magdeburg, Germany
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61
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Busby J, McMenamin Ú, Spence A, Johnston BT, Hughes C, Cardwell CR. Angiotensin receptor blocker use and gastro-oesophageal cancer survival: a population-based cohort study. Aliment Pharmacol Ther 2018; 47:279-288. [PMID: 29105106 DOI: 10.1111/apt.14388] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/04/2017] [Accepted: 09/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Angiotensin receptor blockers (ARBs; including candesartan, losartan, olmesartan and valsartan) are widely used to treat hypertension, heart failure and diabetic neuropathy. There is considerable pre-clinical evidence that ARBs can reduce cancer progression, particularly for gastric cancer. Despite this, epidemiological studies have yet to assess the impact of ARB use on gastro-oesophageal cancer survival. AIM To investigate the association between post-diagnosis ARB use and gastro-oesophageal cancer survival. METHODS We selected a cohort of patients with newly-diagnosed gastro-oesophageal cancer between 1998 and 2012 from English cancer registries. We linked to prescription and clinical records from the Clinical Practice Research Datalink, and to death records from the Office for National Statistics. We used time-dependant Cox-regression models to calculate hazard ratios (HRs) comparing gastro-oesophageal cancer-specific mortality between post-diagnosis ARB users and non-users, after adjusting for demographics, comorbidities and post-diagnosis aspirin or statin use. RESULTS Our cohort included 5124 gastro-oesophageal cancer patients, of which 360 used ARBs, and 3345 died due to their gastro-oesophageal cancer during follow-up. After adjustment, ARB users had moderately lower risk of gastro-oesophageal cancer mortality than the non-users (HR = 0.83, 95% CI 0.71-0.98). There was evidence of a dose-response relationship with the lowest HRs observed among patients receiving at least 2 years of prescriptions (HR = 0.42, 95% CI 0.25-0.72). CONCLUSIONS In this large population-based gastro-oesophageal cancer cohort, we found moderately reduced cancer-specific mortality among ARB users. However, confirmation in further independent epidemiological studies with sufficient staging information is required.
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Affiliation(s)
- J Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ú McMenamin
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - A Spence
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - B T Johnston
- Belfast Health and Social Care Trust, Belfast, UK
| | - C Hughes
- School of Pharmacy, Clinical and Practice Research Group, Queen's University Belfast, Belfast, UK
| | - C R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
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Abstract
CONTEXT - Patients who receive an upper gastrointestinal endoscopic examination frequently have biopsies taken from the duodenum. Accurate interpretation of duodenal biopsies is essential for patient care. Celiac disease is a common clinical concern, but pathologists need to be aware of other conditions of the duodenum that mimic celiac disease. OBJECTIVE - To review the normal histologic features of duodenal mucosa and describe the clinical and histologic findings in celiac disease and its mimics, listing the differentiating features of biopsies with villous atrophy and epithelial lymphocytosis. DATA SOURCES - The study comprises a literature review of pertinent publications as of November 30, 2016. CONCLUSIONS - Celiac disease is a common cause of abnormal duodenal histology. However, many of the histologic features found in the duodenal biopsy of patients with celiac disease are also present in other conditions that affect the small bowel. Diagnostic precision may be enhanced by obtaining a careful patient history and by ancillary laboratory testing, particularly for the presence of antitissue transglutaminase antibodies.
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Affiliation(s)
- Daniel R Owen
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - David A Owen
- From the Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
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63
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Abstract
Every year many new medications are approved for clinical use, several of which can cause clinically significant gastrointestinal tract toxicity. This article emphasizes the histologic features and differential diagnosis of drug-induced injury to the gastrointestinal mucosa. Ultimately, clinical correlation and cessation of a drug with resolution of symptoms are needed to definitively confirm a drug as a causative factor in mucosal injury. Recognizing histologic features in gastrointestinal biopsies, however, can allow surgical pathologists to play a key role in establishing a diagnosis of drug-induced gastrointestinal toxicity.
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Affiliation(s)
- Heewon A Kwak
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, Chicago, IL, USA
| | - John Hart
- Department of Pathology, University of Chicago, 5841 South Maryland Avenue, MC 6101, Chicago, IL, USA.
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64
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Barge S, Ziol M, Nault JC. Autoimmune-like chronic hepatitis induced by olmesartan. Hepatology 2017; 66:2086-2088. [PMID: 28437842 DOI: 10.1002/hep.29228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/10/2017] [Accepted: 03/23/2017] [Indexed: 12/07/2022]
Affiliation(s)
- Sandrine Barge
- Liver Unit, Jean Verdier Hospital, Paris Seine Saint Denis Hospital, Bondy, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Marianne Ziol
- Liver Unit, Jean Verdier Hospital, Paris Seine Saint Denis Hospital, Bondy, France.,UMR 1162, Functional Genomic of Solid Tumors, INSERM, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
| | - Jean-Charles Nault
- Liver Unit, Jean Verdier Hospital, Paris Seine Saint Denis Hospital, Bondy, France.,UMR 1162, Functional Genomic of Solid Tumors, INSERM, Paris, France.,Unité de Formation et de Recherche Santé Médecine et Biologie humaine, Université Paris 13, Communauté d'Universités et Etablissements Sorbonne Paris Cité, Paris, France
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65
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Negro A, De Marco L, Cesario V, Santi R, Boni MC, Zanelli M. A Case of Moderate Sprue-Like Enteropathy Associated With Telmisartan. J Clin Med Res 2017; 9:1022-1025. [PMID: 29163738 PMCID: PMC5687909 DOI: 10.14740/jocmr3047w] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/02/2017] [Indexed: 12/22/2022] Open
Abstract
Sprue-like enteropathy associated with olmesartan medoxomil use has been recently reported. Its clinical manifestations include diarrhea, weight loss and malabsorption. Duodenal biopsies show villous atrophy (VA) with or without intraepithelial lymphocytosis and inflammation of the lamina propria. Serology for celiac disease (CD) is negative and gluten-free diet does not result in clinical improvement. Symptoms resolve after olmesartan discontinuation. Follow-up biopsies show recovery/improvement of the duodenum. Whether sprue-like enteropathy is a specific adverse reaction to olmesartan or rather a class effect of angiotensin-receptor blockers (ARBs) remains a controversial issue. We report a case of sprue-like enteropathy associated with telmisartan. A 52-year-old man presented with chronic diarrhea, abdominal discomfort and significant weight loss. In the last 3 years, he had been treated with telmisartan 40 mg/day for hypertension after right adrenalectomy for an aldosterone-producing adenoma. Laboratory investigations showed no significant abnormalities: Hb 13.6 g/dL, serum albumin 3.9 g/dL, total cholesterol 193 mg/dL, serum creatinine 0.99 mg/dL, sodium 143.6 mmol/L, K+ 4.3 mmol/L, calcium 9.3 mg/dL, phosphorus 3.9 mg/dL and 25-OH-D3 27.7 ng/mL. Duodenal histology showed subtotal VA and inflammation of the lamina propria. CD serology was negative. HLA-DQ typing showed absence of the DQ2/DQ8 haplotypes. After telmisartan discontinuation, patient’s symptoms subsided, and his body weight increased despite persistence of a gluten-containing diet. Follow-up biopsies at 3 showed progressive duodenal recovery. Very few cases of sprue-like enteropathy associated with ARBs other than olmesartan have been reported. Our case of telmisartan-associated enteropathy further suggests that sprue-like disease may be a class effect of ARBs.
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Affiliation(s)
- Aurelio Negro
- Internal Medicine, Specialized Center of Secondary Hypertension and Gastroenterology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Loredana De Marco
- Unit of Pathology, Department of Oncology and Advanced Technologies, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Valentina Cesario
- Internal Medicine, Specialized Center of Secondary Hypertension and Gastroenterology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Rosaria Santi
- Internal Medicine, Specialized Center of Secondary Hypertension and Gastroenterology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Maria Chiara Boni
- Internal Medicine, Specialized Center of Secondary Hypertension and Gastroenterology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
| | - Magda Zanelli
- Unit of Pathology, Department of Oncology and Advanced Technologies, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy
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van Gils T, Robijn RJ, Bouma G, Neefjes-Borst EA, Mulder CJJ. A Pitfall in Suspected (refractory) Celiac Disease: Losartan-Induced Enteropathy. Am J Gastroenterol 2017; 112:1754-1755. [PMID: 29109495 DOI: 10.1038/ajg.2017.281] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- T van Gils
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - R J Robijn
- Department of Gastroenterology and Hepatology, Rijnstate Ziekenhuis, Arnhem, The Netherlands
| | - G Bouma
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - E A Neefjes-Borst
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - C J J Mulder
- Celiac Center Amsterdam, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
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Umetsu SE, Brown I, Langner C, Lauwers GY. Autoimmune enteropathies. Virchows Arch 2017; 472:55-66. [PMID: 29022145 DOI: 10.1007/s00428-017-2243-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 09/25/2017] [Accepted: 09/29/2017] [Indexed: 12/14/2022]
Abstract
Autoimmune enteropathy (AIE) is a rare condition characterized by intractable diarrhea and immune-mediated injury of the intestinal mucosa. As the clinical and histopathologic manifestations of this disease are highly variable, its diagnosis is challenging for both clinicians and pathologists. In fact, the term autoimmune enteropathies is likely more appropriate since the clinicopathologic manifestations are observed in association with a heterogeneous group of disorders. The pathophysiology of AIE has not been fully elucidated. It appears to result from dysregulation of intestinal immunity and particularly in children, often presents in association with immunodeficiency. The overarching histopathologic changes seen in AIE include mucosal inflammation and epithelial injury, although this can manifest in the form of different patterns. Recognition of the clinical settings and of the various histologic patterns can aid the pathologist in establishing the correct diagnosis.
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Affiliation(s)
- Sarah E Umetsu
- Department of Pathology, University of California, San Francisco, 505 Parnassus Avenue, Room M551A, Box 0102, San Francisco, CA, 94143-0102, USA.
| | - Ian Brown
- Envoi Pathology, Kelvin Grove, Qld, Australia
| | - Cord Langner
- Institute of Pathology, Medical University of Graz, Graz, Austria
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68
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De Bortoli N, Ripellino C, Cataldo N, Marchi S. Unspecified intestinal malabsorption in patients treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers: a retrospective analysis in primary care settings. Expert Opin Drug Saf 2017; 16:1221-1225. [PMID: 28871813 DOI: 10.1080/14740338.2017.1376647] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the possible relationship between the use of Angiotensin II Receptor Blockers (ARBs) or Angiotensin-Converting-Enzyme Inhibitors (ACE-i) and unspecified intestinal malabsorption (IM) within the Italian and German real-life context. RESEARCH DESIGN AND METHODS a retrospective cohort of patients with a new unspecified IM diagnosis during the period 1 January 2010-31 December 2013 was extracted from Italian IMS Health Longitudinal Patient Database and German IMS Disease Analyzer. Only patients with at least one prescription of ARB or ACE-i medication during the 6 months preceding the IM diagnosis were included and then followed up for 12 months to assess treatment exposure. RESULTS After stratification by year and molecule, the proportion of patients experiencing an unspecified IM diagnosis on total patients receiving ARBs or ACE-i ranged from 0% to 0.14%, showing no relevant differences between molecules and no time trends. CONCLUSIONS this study indicates that ACE-i or ARBs were rarely associated to an unspecified IM diagnosis. No relevant difference between each specific ACE-i and ARB was highlighted.
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Affiliation(s)
- Nicola De Bortoli
- a Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy
| | - Claudio Ripellino
- b Department of Real World Evidence , HEOR Consultant Freelance , Milan , Italy
| | - Nazarena Cataldo
- c Department of Real World Evidence , QuintilesIMS , Milan , Italy
| | - Santino Marchi
- a Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery , University of Pisa , Pisa , Italy
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69
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Clinical and Histologic Mimickers of Celiac Disease. Clin Transl Gastroenterol 2017; 8:e114. [PMID: 28817113 PMCID: PMC5587842 DOI: 10.1038/ctg.2017.41] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023] Open
Abstract
Celiac disease is an autoimmune disorder of the small bowel, classically associated with diarrhea, abdominal pain, and malabsorption. The diagnosis of celiac disease is made when there are compatible clinical features, supportive serologic markers, representative histology from the small bowel, and response to a gluten-free diet. Histologic findings associated with celiac disease include intraepithelial lymphocytosis, crypt hyperplasia, villous atrophy, and a chronic inflammatory cell infiltrate in the lamina propria. It is important to recognize and diagnose celiac disease, as strict adherence to a gluten-free diet can lead to resolution of clinical and histologic manifestations of the disease. However, many other entities can present with clinical and/or histologic features of celiac disease. In this review article, we highlight key clinical and histologic mimickers of celiac disease. The evaluation of a patient with serologically negative enteropathy necessitates a carefully elicited history and detailed review by a pathologist. Medications can mimic celiac disease and should be considered in all patients with a serologically negative enteropathy. Many mimickers of celiac disease have clues to the underlying diagnosis, and many have a targeted therapy. It is necessary to provide patients with a correct diagnosis rather than subject them to a lifetime of an unnecessary gluten-free diet.
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70
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Zanelli M, Negro A, Santi R, Bisagni A, Ragazzi M, Ascani S, De Marco L. Letter: sprue-like enteropathy associated with angiotensin II receptor blockers other than olmesartan. Aliment Pharmacol Ther 2017; 46:471-473. [PMID: 28707802 DOI: 10.1111/apt.14176] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- M Zanelli
- Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
| | - A Negro
- Internal Medicine and Hypertension Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
| | - R Santi
- Internal Medicine and Hypertension Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
| | - A Bisagni
- Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
| | - M Ragazzi
- Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
| | - S Ascani
- Institute of Pathology, Ospedale di Terni, University of Perugia, Perugia, Italy
| | - L De Marco
- Pathology Unit, Arcispedale Santa Maria Nuova IRCCS, Reggio Emila, Italy
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71
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Marthey L, Carbonnel F. Letter: sprue-like enteropathy associated with angiotensin II receptor blockers other than olmesartan-authors'reply. Aliment Pharmacol Ther 2017; 46:473-474. [PMID: 28707797 DOI: 10.1111/apt.14191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- L Marthey
- Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Le Kremlin Bicêtre, France
| | - F Carbonnel
- Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, Assistance Publique-Hôpitaux de Paris, Université Paris-Sud, Le Kremlin Bicêtre, France
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72
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Adike A, Corral J, Rybnicek D, Sussman D, Shah S, Quigley E. Olmesartan-Induced Enteropathy. Methodist Debakey Cardiovasc J 2017; 12:230-232. [PMID: 28289500 DOI: 10.14797/mdcj-12-4-230] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Olmesartan-induced enteropathy mimics celiac disease clinically and pathologically. As in celiac disease, the pathologic findings are villous atrophy and increased intraepithelial lymphocytes. Clinical presentation of olmesartan-induced enteropathy includes diarrhea, weight loss, and nausea. In contrast to celiac disease, tissue transglutaminase is not elevated and there is no response to a gluten-free diet. Including this entity in the differential diagnosis of sprue-like enteropathy is critical for its early diagnosis since replacing olmesartan with an alternative antihypertensive drug can simplify the diagnostic workup and provide both clinical and histologic improvement.
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Affiliation(s)
| | - Juan Corral
- University of Miami Miller School of Medicine, Miami, Florida
| | - David Rybnicek
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel Sussman
- University of Miami Miller School of Medicine, Miami, Florida
| | - Samir Shah
- Alpert Medical School, Brown University, Providence, Rhode Island
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73
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Ebrahim VS, Martin J, Murthy S, Odstrcil E, Huang H, Polter D. Olmesartan-associated enteropathy. Proc AMIA Symp 2017; 30:348-350. [PMID: 28670083 PMCID: PMC5468041 DOI: 10.1080/08998280.2017.11929644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Olmesartan, an angiotensin-receptor blocker frequently prescribed for hypertension, has been commercially available since 2002. In 2012, olmesartan-associated enteropathy was described, and the Food and Drug Administration now requires a black-box warning for olmesartan regarding severe diarrhea. The disorder can be life-threatening and often requires hospitalization. We present three cases that represent different aspects of this disorder, as well as some unusual features.
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Affiliation(s)
- Vivian S Ebrahim
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
| | - Jason Martin
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
| | - Stacey Murthy
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
| | - Elizabeth Odstrcil
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
| | - He Huang
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
| | - Daniel Polter
- Division of Gastroenterology, Department of Internal Medicine (Ebrahim, Martin, Odstrcil, Polter) and the Department of Pathology (Murthy, Huang), Baylor University Medical Center, Dallas, Texas
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74
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Calvo Beguería E, Martinez Huguet C, Gonzalez García MP, Omiste SanVicente T. [Sprue-like enteropathy in the elderly treated with olmesartan]. Rev Esp Geriatr Gerontol 2017; 52:223-224. [PMID: 28277303 DOI: 10.1016/j.regg.2016.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/24/2016] [Accepted: 09/09/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Eva Calvo Beguería
- Servicio de Medicina Interna, Hospital General San Jorge, Huesca, España.
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75
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Mandavdhare HS, Sharma V, Prasad KK, Kumar A, Rathi M, Rana SS. Telmisartan-induced sprue-like enteropathy: a case report and a review of patients using non-olmesartan angiotensin receptor blockers. Intest Res 2017; 15:419-421. [PMID: 28670240 PMCID: PMC5478768 DOI: 10.5217/ir.2017.15.3.419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 11/29/2022] Open
Abstract
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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Affiliation(s)
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kaushal K Prasad
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Kumar
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder S Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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76
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Pekki H, Kurppa K, Mäki M, Huhtala H, Laurila K, Ilus T, Kaukinen K. Performing routine follow-up biopsy 1 year after diagnosis does not affect long-term outcomes in coeliac disease. Aliment Pharmacol Ther 2017; 45:1459-1468. [PMID: 28326597 DOI: 10.1111/apt.14048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/15/2017] [Accepted: 02/26/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND A repeat biopsy is recommended, but often omitted in coeliac disease patients on a gluten-free diet. The effect of performing or not performing repeat biopsies is currently unknown. AIM To identify factors associated with and the significance of lacking biopsy for long-term outcome. Predictors and the importance of incomplete histological recovery after 1 year was investigated in re-biopsied patients. METHODS A total of 760 patients participated in a nationwide follow-up study. Medical data were gathered via interviews and patient records, and blood samples were drawn for serology. Current symptoms and well-being were assessed by validated PGWB, SF-36 and GSRS questionnaires. RESULTS Malabsorption was more common among those with a repeat biopsy (46%) than those without repeat biopsy (33%), P < 0.001, as were severe symptoms at diagnosis (24% vs. 16%, P = 0.05) and concomitant gastrointestinal (40% vs. 32%, P = 0.049) or musculoskeletal (35% vs. 27%, P = 0.023) diseases such as arthritis, osteoporosis and back pain. Repeat biopsy was more rare in subjects diagnosed in private care (11% vs. 23%, P < 0.001) or by screening (10% vs. 16%, P = 0.010). The groups were comparable as to current symptoms and dietary adherence, but those without re-biopsy were less confident of their diet (89% vs. 94%, P = 0.002) and more often seropositive on diet (14% vs. 9%, P = 0.012). They reported better SF-36 physical functioning (P = 0.043) and less pain and indigestion (P = 0.013 and P = 0.046 respectively) and total GSRS (P = 0.052) score. Incomplete mucosal recovery was predicted by more advanced histological (P < 0.001) and serological (P = 0.001) disease at diagnosis, whereas the groups did not differ in long-term adherence, symptoms, seropositivity, questionnaire scores, frequency of fractures or malignancies. CONCLUSIONS Severe disease at diagnosis predicted the record of a repeat biopsy and incomplete mucosal recovery. Neither lacking biopsy nor incomplete recovery in a relative short time span of 1 year was associated with poorer long-term outcome, although survival bias cannot be excluded.
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Affiliation(s)
- H Pekki
- The Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - K Kurppa
- Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - M Mäki
- Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - H Huhtala
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - K Laurila
- Tampere Center for Child Health, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - T Ilus
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
| | - K Kaukinen
- The Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Internal Medicine, Tampere University Hospital, Tampere, Finland
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77
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Abstract
Inappropriate activation of the renin-angiotensin system (RAS) exacerbates renal and vascular injury. Accordingly, treatment with global RAS antagonists attenuates cardiovascular risk and slows the progression of proteinuric kidney disease. By reducing BP, RAS inhibitors limit secondary immune activation responding to hemodynamic injury in the target organ. However, RAS activation in hematopoietic cells has immunologic effects that diverge from those of RAS stimulation in the kidney and vasculature. In preclinical studies, activating type 1 angiotensin (AT1) receptors in T lymphocytes and myeloid cells blunts the polarization of these cells toward proinflammatory phenotypes, protecting the kidney from hypertensive injury and fibrosis. These endogenous functions of immune AT1 receptors temper the pathogenic actions of renal and vascular AT1 receptors during hypertension. By counteracting the effects of AT1 receptor stimulation in the target organ, exogenous administration of AT2 receptor agonists or angiotensin 1-7 analogs may similarly limit inflammatory injury to the heart and kidney. Moreover, although angiotensin II is the classic effector molecule of the RAS, several RAS enzymes affect immune homeostasis independently of canonic angiotensin II generation. Thus, as reviewed here, multiple components of the RAS signaling cascade influence inflammatory cell phenotype and function with unpredictable and context-specific effects on innate and adaptive immunity.
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Affiliation(s)
- Steven D Crowley
- Division of Nephrology, Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
| | - Nathan P Rudemiller
- Division of Nephrology, Department of Medicine, Durham Veterans Affairs and Duke University Medical Centers, Durham, North Carolina
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78
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Zhang X, Zhang H, Ma Y, Che W, Hamblin MR. Management of Hypertension Using Olmesartan Alone or in Combination. Cardiol Ther 2017; 6:13-32. [PMID: 28258390 PMCID: PMC5446820 DOI: 10.1007/s40119-017-0087-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Indexed: 12/19/2022] Open
Abstract
Hypertension is one of the most significant and consistent risk factors for many cardiovascular diseases. The global prevalence of hypertension has dramatically increased over recent years. Life-style and genetic factors are generally considered to be primarily responsible for the incidence of hypertension. Concerning the high morbidity rate, setting up an updated standard for hypertensive patients becomes indispensable. According to the widely accepted standard treatments for hypertension, these four basic principles should be taken into account: low dosage; medication should provide long term-control; combination therapies are becoming common; personalized treatments are a newer approach. In most patients with hypertension, adequate control of BP can be achieved with combined therapy. Therefore, antihypertensive agents with complementary mechanisms are now recommended. In this review, we focus on the pharmacology, antihypertensive efficacy, and adverse events (AEs) of olmesartan medoxomil, either alone or in combination with other antihypertensive medications. In conclusion, olmesartan medoxomil, is an angiotensin II receptor blocker with an excellent efficacy in the reduction and stabilization of blood pressure. When combined with calcium channel blockers (CCBs) and diuretics, olmesartan medoxomil has a better effect on controlling BP and reducing AEs in patients.
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Affiliation(s)
- Xiaoshen Zhang
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China.,Tongji University Cancer Institute, Tongji University School of Medicine, Shanghai, 200092, China.,Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Han Zhang
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China
| | - Yuxia Ma
- Department of Internal Medicine, Cangzhou Central Hospital, Cangzhou, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth Hospital of Tongji University, Shanghai, 200072, China
| | - Michael R Hamblin
- Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA, 02114, USA. .,Department of Dermatology, Harvard Medical School, Boston, MA, 02115, USA. .,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, 02139, USA.
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79
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Elli L, Branchi F, Sidhu R, Guandalini S, Assiri A, Rinawi F, Shamir R, Das P, Makharia GK. Small bowel villous atrophy: celiac disease and beyond. Expert Rev Gastroenterol Hepatol 2017; 11:125-138. [PMID: 28000520 DOI: 10.1080/17474124.2017.1274231] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Small bowel villous atrophy can represent a diagnostic challenge for gastroenterologists and pathologists. In Western countries small bowel atrophy and mild non-atrophic alterations are frequently caused by celiac disease. However, other pathology can mimic celiac disease microscopically, widening the differential diagnosis. The several novelties on this topic and the introduction of the device-assisted enteroscopy in the diagnostic flowchart make an update of the literature necessary. Areas covered: In this review, a description of the different clinical scenarios when facing with small bowel mucosal damage, particularly small bowel atrophy, is described. The published literature on this subject has been summarized and reviewed. Expert commentary: When an intestinal mucosal alteration is histologically demonstrated, the pathology report forms part of a more complex workup including serological data, clinical presentation and clinical history. A multidisciplinary team, including pathologists and enteroscopy-devoted endoscopists, is frequently required to manage patients with small bowel alterations, especially in cases of severe malabsorption syndrome.
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Affiliation(s)
- Luca Elli
- a Center for Prevention and Diagnosis of Celiac Disease , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - Federica Branchi
- a Center for Prevention and Diagnosis of Celiac Disease , Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milano , Italy
| | - Reena Sidhu
- b Department of Gastroenterology , University of Sheffield, Royal Hallamshire Hospital , Sheffield , United Kingdom
| | - Stefano Guandalini
- c Department of Pediatrics, Section of Pediatric Gastroenterology , Hepatology and Nutrition, Celiac Disease Center, University of Chicago , Chicago , IL , USA
| | - Asaad Assiri
- d Prince Abdullah Bin Khalid Coeliac Disease Research Chair King Saud University , Riyadh , Saudi Arabia
| | - Firas Rinawi
- e Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center , Petach Tikva , Israel
| | - Raanan Shamir
- f Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel AND Sackler Faculty of Medicine , Tel-Aviv University , Tel Aviv , Israel
| | - Prasenjit Das
- g Department of Pathology , All India Institute of Medical sciences , New Delhi , India
| | - Govind K Makharia
- h Department of Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
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80
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Basson M, Mezzarobba M, Weill A, Ricordeau P, Allemand H, Alla F, Carbonnel F. Severe intestinal malabsorption associated with olmesartan: a French nationwide observational cohort study. Gut 2016; 65:1664-9. [PMID: 26250345 DOI: 10.1136/gutjnl-2015-309690] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/06/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Severe sprue-like enteropathy associated with olmesartan has been reported, but there has been no demonstration of an increased risk by epidemiological studies. AIM To assess, in a nationwide patient cohort, the risk of hospitalisation for intestinal malabsorption associated with olmesartan compared with other angiotensin receptor blockers (ARB) and ACE inhibitors (ACEIs). DESIGN From the French National Health Insurance claim database, all adult patients initiating ARB or ACEI between 1 January 2007 and 31 December 2012 with no prior hospitalisation for intestinal malabsorption, no serology testing for coeliac disease and no prescription for a gluten-free diet product were included. Incidence of hospitalisation with a discharge diagnosis of intestinal malabsorption was the primary endpoint. RESULTS 4 546 680 patients (9 010 303 person-years) were included, and 218 events observed. Compared with ACEI, the adjusted rate ratio of hospitalisation with a discharge diagnosis of intestinal malabsorption was 2.49 (95% CI 1.73 to 3.57, p<0.0001) in olmesartan users. This adjusted rate ratio was 0.76 (95% CI 0.39 to 1.49, p=0.43) for treatment duration shorter than 1 year, 3.66 (95% CI 1.84 to 7.29, p<0.001) between 1 and 2 years and 10.65 (95% CI 5.05 to 22.46, p<0.0001) beyond 2 years of exposure. Median length of hospital stay for intestinal malabsorption was longer in the olmesartan group than in the other groups (p=0.02). Compared with ACEI, the adjusted rate ratio of hospitalisation for coeliac disease was 4.39 (95% CI 2.77 to 6.96, p<0.0001) in olmesartan users and increased with treatment duration. CONCLUSIONS Olmesartan is associated with an increased risk of hospitalisation for intestinal malabsorption and coeliac disease.
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Affiliation(s)
| | | | - Alain Weill
- French National Health Insurance Fund, Paris, France
| | | | | | - Francois Alla
- French National Health Insurance Fund, Paris, France
| | - Franck Carbonnel
- Université Paris-Sud, Assistance Publique-Hôpitaux de Paris and Gastroenterology unit, Hôpitaux Universitaires Paris Sud, Le Kremlin Bicêtre, France
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81
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Lau MSY, Mooney P, White W, Appleby V, Moreea S, Haythem I, Elias J, Bundhoo K, Corbett G, Wong L, Tsai HH, Cross S, Hebden J, Hoque S, Sanders D. 'Pre-endoscopy point of care test (Simtomax- IgA/IgG-Deamidated Gliadin Peptide) for coeliac disease in iron deficiency anaemia: diagnostic accuracy and a cost saving economic model'. BMC Gastroenterol 2016; 16:115. [PMID: 27628523 PMCID: PMC5024457 DOI: 10.1186/s12876-016-0521-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/16/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND International guidelines recommend coeliac serology in iron deficiency anaemia, and duodenal biopsy for those tested positive to detect coeliac disease. However, pre-endoscopy serology is often unavailable, thus committing endoscopists to take routine duodenal biopsies. Some endoscopists consider duodenal biopsy mandatory in anaemia to exclude other pathologies. We hypothesise that using a point of care test at endoscopy could fill this gap, by providing rapid results to target anaemic patients who require biopsies, and save costs by biopsy avoidance. We therefore assessed three key aspects to this hypothesis: 1) the availability of pre-endoscopy serology in anaemia; 2) the sensitivities and cost effectiveness of pre-endoscopy coeliac screening with Simtomax in anaemia; 3) whether other anaemia-related pathologies could be missed by this targeted-biopsy approach. METHODS Group 1: pre-endoscopy serology availability was retrospectively analysed in a multicentre cohort of 934 anaemic patients at 4 UK hospitals. Group 2: the sensitivities of Simtomax, endomysial and tissue-transglutaminase antibodies were compared in 133 prospectively recruited patients with iron deficiency anaemia attending for a gastroscopy. The sensitivities were measured against duodenal histology as the reference standard in all patients. The cost effectiveness of Simtomax was calculated based on the number of biopsies that could have been avoided compared to an all-biopsy approach. Group 3: the duodenal histology of 153 patients presenting to a separate iron deficiency anaemia clinic were retrospectively reviewed. RESULTS In group 1, serology was available in 361 (33.8 %) patients. In group 2, the sensitivity and negative predictive value (NPV) were 100 % and 100 % for Simtomax, 96.2 % and 98.9 % for IgA-TTG, and 84.6 % and 96.4 % for EMA respectively. In group 3, the duodenal histology found no causes for anaemia other than coeliac disease. CONCLUSION Simtomax had excellent diagnostic accuracy in iron deficiency anaemia and was comparable to conventional serology. Duodenal biopsy did not identify any causes other than coeliac disease for iron deficiency anaemia, suggesting that biopsy avoidance in Simtomax negative anaemic patients is unlikely to miss other anaemia-related pathologies. Due to its 100 % NPV, Simtomax could reduce unnecessary biopsies by 66 % if only those with a positive Simtomax were biopsied, potentially saving £3690/100 gastroscopies. TRIAL REGISTRATION The group 2 study was retrospectively registered with clinicaltrials.gov. Trial registration date: 13(th) July 2016; TRIAL REGISTRATION NUMBER NCT02834429 .
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Affiliation(s)
- Michelle Shui Yee Lau
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
| | - Peter Mooney
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - William White
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Victoria Appleby
- Department of Gastroenterology, Bradford Royal Infirmary, Bradford, UK
| | - Sulleman Moreea
- Department of Gastroenterology, Bradford Royal Infirmary, Bradford, UK
| | - Ismail Haythem
- Department of Gastroenterology, Whipps Cross University Hospital, London, UK
| | - Joshua Elias
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Kiran Bundhoo
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Gareth Corbett
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Liam Wong
- Department of Gastroenterology, Hull Royal Infirmary, Hull, UK
| | - Her Hsin Tsai
- Department of Gastroenterology, Hull Royal Infirmary, Hull, UK
| | - Simon Cross
- Academic Unit of Pathology, Department of Neuroscience, Faculty of Medicine, Dentistry & Health, The University of Sheffield, Sheffield, UK
| | - John Hebden
- Department of Gastroenterology, Northern General Hospital, Sheffield Teaching Hospitals, Sheffield, UK
| | - Sami Hoque
- Department of Gastroenterology, Whipps Cross University Hospital, London, UK
| | - David Sanders
- Academic Department of Gastroenterology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK
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Classification chaos in coeliac disease: Does it really matter? Pathol Res Pract 2016; 212:1174-1178. [PMID: 27637158 DOI: 10.1016/j.prp.2016.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
The spectrum of mucosal pathology in coeliac disease (CD), initially defined by Marsh in 1992 has been subjected to several modifications in the following years by Oberhuber, then by Corazza and Villanaci, and finally by Ensari. The present study, aimed to end the ongoing confusion regarding the classification of mucosal pathology in CD by applying all the classifications proposed so far on a large series of cases. A total of 270 duodenal biopsies taken from the distal duodenum of patients with a diagnosis of CD were included in the study. All biopsies were classified according to Marsh, Oberhuber, Corazza Villanaci, and Ensari classification schemes. For statistical analyses cases were divided into three groups: Group 1 included type 1 lesions in Marsh, Ensari, and Oberhuber and grade A in Corazza Villanaci classifications. Group 2 comprised of type 2 lesions in Marsh and Ensari classifications together with type2, type 3a and 3b lesions in Oberhuber classification and grade B1 lesions in Corazza Villanaci classification. Group 3 included type 3 lesions in Marsh and Ensari classifications, and type 3c lesions in Oberhuber, and grade B2 lesions in Corazza Villanaci classifications. The kappa value was 1.00 (excellent) for group 1, 0.53 (fair) for group 2 and 0.78 (excellent) for group 3 (p<0.0001). These results suggest that any of the above classification system would serve similar purposes in the diagnosis of CD. Therefore, it is advisable that the pathologist should use the simplest reliable scheme.
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83
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Volta U, Caio G, Boschetti E, Giancola F, Rhoden KJ, Ruggeri E, Paterini P, De Giorgio R. Seronegative celiac disease: Shedding light on an obscure clinical entity. Dig Liver Dis 2016; 48:1018-22. [PMID: 27352981 DOI: 10.1016/j.dld.2016.05.024] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although serological tests are useful for identifying celiac disease, it is well established that a minority of celiacs are seronegative. AIM To define the prevalence and features of seronegative compared to seropositive celiac disease, and to establish whether celiac disease is a common cause of seronegative villous atrophy. METHODS Starting from 810 celiac disease diagnoses, seronegative patients were retrospectively characterized for clinical, histological and laboratory findings. RESULTS Of the 810 patients, fourteen fulfilled the diagnostic criteria for seronegative celiac disease based on antibody negativity, villous atrophy, HLA-DQ2/-DQ8 positivity and clinical/histological improvement after gluten free diet. Compared to seropositive, seronegative celiac disease showed a significantly higher median age at diagnosis and a higher prevalence of classical phenotype (i.e., malabsorption), autoimmune disorders and severe villous atrophy. The most frequent diagnosis in the 31 cases with seronegative flat mucosa was celiac disease (45%), whereas other diagnoses were Giardiasis (20%), common variable immunodeficiency (16%) and autoimmune enteropathy (10%). CONCLUSIONS Although rare seronegative celiac disease can be regarded as the most frequent cause of seronegative villous atrophy being characterized by a high median age at diagnosis; a close association with malabsorption and flat mucosa; and a high prevalence of autoimmune disorders.
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Affiliation(s)
- Umberto Volta
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Giacomo Caio
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Elisa Boschetti
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Fiorella Giancola
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Kerry J Rhoden
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Eugenio Ruggeri
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Paola Paterini
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy
| | - Roberto De Giorgio
- Department of Medical and Surgical Sciences, University of Bologna, St. Orsola-Malpighi Hospital, Italy.
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Schiepatti A, Biagi F, Cumetti D, Luinetti O, Sonzogni A, Mugellini A, Corazza GR. Olmesartan-associated enteropathy: new insights on the natural history? Report of two cases. Scand J Gastroenterol 2016; 51:152-6. [PMID: 26291698 DOI: 10.3109/00365521.2015.1074719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The association between olmesartan and an enteropathy histologically indistinguishable from untreated celiac disease has recently been described. However, pathogenetic mechanisms leading to villous atrophy, prevalence, natural history and genetic background of this condition have not yet been defined. PATIENTS We describe here two cases of olmesartan-associated enteropathy and discuss some aspects of the natural history of this condition. RESULTS In both patients, an infectious episode seems to have triggered the severe malabsorption syndrome which led them to hospitalization. High titer positive antinuclear antibodies with homogeneous pattern were found. CONCLUSIONS Our reports add to a growing body of evidence suggesting that olmesartan-associated enteropathy should be considered in the presence of villous atrophy and negative celiac serology and in the diagnostic algorithm of non-responsive celiac disease.
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Affiliation(s)
- Annalisa Schiepatti
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Federico Biagi
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Davide Cumetti
- b Department of Internal Medicine , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy
| | - Ombretta Luinetti
- c Department of Pathology , Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | - Aurelio Sonzogni
- d Department of Pathology , Azienda Ospedaliera Papa Giovanni XXIII , Bergamo , Italy , and
| | - Amedeo Mugellini
- e Second Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
| | - Gino R Corazza
- a First Department of Internal Medicine , Fondazione IRCCS Policlinico San Matteo, University of Pavia , Pavia , Italy
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85
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Kodati D, Kotakonda HK, Yellu N. Population Pharmacokinetic Modeling of Olmesartan, the Active Metabolite of Olmesartan Medoxomil, in Patients with Hypertension. Eur J Drug Metab Pharmacokinet 2016; 42:573-581. [PMID: 27535556 DOI: 10.1007/s13318-016-0371-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Olmesartan medoxomil is an orally given angiotensin II receptor antagonist indicated for the treatment of hypertension. OBJECTIVE The aim of the study was to establish a population pharmacokinetic model for olmesartan, the active metabolite of olmesartan medoxomil, in Indian hypertensive patients, and to evaluate effects of covariates on the volume of distribution (V/F) and oral clearance (CL/F) of olmesartan. METHODS The population pharmacokinetic model for olmesartan was developed using Phoenix NLME 1.3 with a non-linear mixed-effect model. Bootstrap and visual predictive check were used simultaneously to validate the final population pharmacokinetic models. The covariates included age, sex, body surface area (BSA), bodyweight, height, creatinine clearance (CLCR) as an index of renal function and liver parameters as indices of hepatic function. RESULTS A total of 205 olmesartan plasma sample concentrations from 69 patients with hypertension were collected in this study. The pharmacokinetic data of olmesartan was well described by a two-compartment linear pharmacokinetic model with first-order absorption and an absorption lag-time. The mean values of CL/F and V/F of olmesartan in the patients were 0.31565 L/h and 44.5162 L, respectively. Analysis of covariates showed that age and CLCR were factors influencing the clearance of olmesartan and the volume of distribution of olmesartan was dependent on age and BSA. CONCLUSION The final population pharmacokinetic model was demonstrated to be appropriate and effective and it can be used to assess the pharmacokinetic parameters of olmesartan in Indian patients with hypertension.
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Affiliation(s)
- Devender Kodati
- Department of Pharmacology and DMPK, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, 506009, India
| | | | - Narsimhareddy Yellu
- Department of Pharmacology and DMPK, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana, 506009, India.
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86
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Rishi A, Garland K. Unusual Severe Side Effect of a Commonly Used Drug. J Clin Hypertens (Greenwich) 2016; 18:363. [DOI: 10.1111/jch.12705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Abdul Rishi
- Department of Internal Medicine; Mercy Hospital; Saint Louis MO
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87
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Hujoel IA, Rubio-Tapia A. Sprue-Like Enteropathy Associated With Olmesartan: A New Kid on the Enteropathy Block. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:61-65. [PMID: 28868435 PMCID: PMC5580180 DOI: 10.1016/j.jpge.2016.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Isabel A Hujoel
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alberto Rubio-Tapia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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88
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Hammoudi N, Dior M, Giraud V, Coffin B. Olmesartan-induced enteropathy associated with cutaneous lesions. Clin Case Rep 2016; 4:379-82. [PMID: 27099732 PMCID: PMC4831388 DOI: 10.1002/ccr3.531] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/06/2016] [Accepted: 02/10/2016] [Indexed: 01/26/2023] Open
Abstract
Olmesartan is an angiotensin II receptor antagonist which may cause severe sprue‐like enteropathy with duodenal villous atrophy. Skin lesions may be associated as reported for the first time in our case. Clinicians should be informed of this side effect and its reversibility after suspension of the drug.
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Affiliation(s)
- Nassim Hammoudi
- Department of Gastroenterology Louis Mourier Teaching Hospital Colombes France; Denis Diderot University Paris 7 Paris France
| | - Marie Dior
- Department of Gastroenterology Louis Mourier Teaching Hospital Colombes France; Denis Diderot University Paris 7 Paris France
| | - Vincent Giraud
- Doctor's office 20 avenue de l'Europe 78000 Versailles France
| | - Benoit Coffin
- Department of Gastroenterology Louis Mourier Teaching Hospital Colombes France; Denis Diderot University Paris 7 Paris France
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89
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Campos Ruiz A, Urtasun Arlegui L, Marra-López Valenciano C. Sprue-like enteropathy linked to olmesartan. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:292-3. [PMID: 26925975 DOI: 10.17235/reed.2016.4140/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Olmesartan is a therapy used for the management of hypertension available since 2002. A sprue like enteropathy associated with olmesartan has been first described in 2012. Endoscopic and histopathological findings are partial or total villous atrophy, mimicking a Celiac Disease. We explain two cases diagnosed in our hospital. Both patients took more than one year of treatment with olmesartan. In both cases, the biopsy showed duodenal villous atrophy, negative serology for celiac disease and they improved after stopping treatment with olmesartan. Olmesartan associate sprue-like enteropathy should be included in the differential diagnosis of seronegative villous atrophy. After the discontinuation of olmesartan, clinical remission usually occurs in every patients.
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90
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Imperatore N, Tortora R, Capone P, Caporaso N, Rispo A. An emerging issue in differential diagnosis of diarrhea: sprue-like enteropathy associated with olmesartan. Scand J Gastroenterol 2016; 51:378-80. [PMID: 26554620 DOI: 10.3109/00365521.2015.1083051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- N Imperatore
- a Antonio Rispo, Gastroenterology, Department of Clinical Medicine and Surgery , University "Federico II" of Naples , Via S. Pansini 5, 80131 , Naples , Italy
| | - R Tortora
- a Antonio Rispo, Gastroenterology, Department of Clinical Medicine and Surgery , University "Federico II" of Naples , Via S. Pansini 5, 80131 , Naples , Italy
| | - P Capone
- a Antonio Rispo, Gastroenterology, Department of Clinical Medicine and Surgery , University "Federico II" of Naples , Via S. Pansini 5, 80131 , Naples , Italy
| | - N Caporaso
- a Antonio Rispo, Gastroenterology, Department of Clinical Medicine and Surgery , University "Federico II" of Naples , Via S. Pansini 5, 80131 , Naples , Italy
| | - A Rispo
- a Antonio Rispo, Gastroenterology, Department of Clinical Medicine and Surgery , University "Federico II" of Naples , Via S. Pansini 5, 80131 , Naples , Italy
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91
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Eusébio M, Caldeira P, Antunes AG, Ramos A, Velasco F, Cadillá J, Guerreiro H. Olmesartan-Induced Enteropathy: An Unusual Cause of Villous Atrophy. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:91-95. [PMID: 28868439 PMCID: PMC5579990 DOI: 10.1016/j.jpge.2015.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/14/2015] [Indexed: 12/20/2022]
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.
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Affiliation(s)
- Marta Eusébio
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Paulo Caldeira
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Artur Gião Antunes
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - André Ramos
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Francisco Velasco
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Jesús Cadillá
- Pathology Department, Centro Hospitalar do Algarve, EPE, Faro, Portugal
| | - Horácio Guerreiro
- Gastroenterology Departament, Centro Hospitalar do Algarve, EPE, Faro, Portugal
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92
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Esteve M, Temiño R, Carrasco A, Batista L, Del Val A, Blé M, Santaolaria S, Molina-Infante J, Soriano G, Agudo S, Zabana Y, Andújar X, Aceituno M, Ribes J, Madridejos R, Fernández-Bañares F. Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: A population-based study. Dig Liver Dis 2016; 48:154-61. [PMID: 26699826 DOI: 10.1016/j.dld.2015.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/12/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
AIMS (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity. METHODS Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients. RESULTS Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers. CONCLUSIONS Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.
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Affiliation(s)
- Maria Esteve
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
| | - Rocío Temiño
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain
| | - Anna Carrasco
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Lissette Batista
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain
| | - Adolfo Del Val
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Michel Blé
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Germán Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Sandra Agudo
- Department of Gastroenterology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Xavier Andújar
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Montserrat Aceituno
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Josepa Ribes
- Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain; Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Rosa Madridejos
- Department of Pharmacy, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
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93
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Olmesartan-Induced Sprue Like Enteropathy. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:101-105. [PMID: 28868441 PMCID: PMC5580175 DOI: 10.1016/j.jpge.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/06/2015] [Indexed: 11/22/2022]
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.
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94
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Uehara T, Ikusaka M, Ohira Y, Noda K, Suzuki S, Shikino K, Kondo T, Kajiwara H, Ikegami A, Hirota Y. Olmesartan-induced Enteropathy Manifesting as Wernicke-Korsakoff Syndrome. Intern Med 2016; 55:3675-3678. [PMID: 27980272 PMCID: PMC5283972 DOI: 10.2169/internalmedicine.55.7388] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Cases of sprue-like enteropathy associated with olmesartan have sporadically been encountered since it was first reported in 2012, and their most characteristic manifestation is severe diarrhea. We herein report the first case of sprue-like enteropathy manifesting as Wernicke-Korsakoff syndrome due to vitamin B1 malabsorption with only minimally increased bowel movements. When patients are receiving olmesartan and they complain of nonspecific chronic gastrointestinal symptoms, it is important to consider changing the drugs before any serious malabsorption syndrome develops.
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Affiliation(s)
- Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Japan
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95
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Adding Water to the Mill: Olmesartan-Induced Collagenous Sprue-A Case Report and Brief Literature Review. Can J Gastroenterol Hepatol 2016; 2016:4837270. [PMID: 27446843 PMCID: PMC4904736 DOI: 10.1155/2016/4837270] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/29/2016] [Indexed: 11/17/2022] Open
Abstract
Collagenous sprue (CS) is a distinct clinicopathological disorder histologically defined by a thickened subepithelial band (Freeman, 2011). It is a rare condition which has been recently observed in a significant proportion of sprue-like enteropathy associated with olmesartan, a novel entity described by Rubio-Tapia et al. in 2012. CS is historically associated with a poor prognosis (Marthey et al., 2014). However, histological and clinical improvements have been described in most studies with concomitant usage of corticosteroids and/or gluten-free diet (Marthey et al., 2014). We report a unique case of olmesartan-induced collagenous sprue in a 79-year-old man that showed complete histological and clinical remission with the sole withdrawal of the incriminating drug. The literature on this topic is briefly reviewed.
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96
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Duodenal Villous Atrophy in a TTG-Negative Patient Taking Olmesartan: A Case Report and Review of the Literature. Can J Gastroenterol Hepatol 2016; 2016:6091571. [PMID: 27446852 PMCID: PMC4904703 DOI: 10.1155/2016/6091571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 04/01/2015] [Indexed: 12/03/2022] Open
Abstract
Olmesartan, an angiotensin II receptor antagonist used to treat hypertension, is associated with few adverse effects. Here, a case of severe sprue-like enteropathy and acute kidney injury is described in a 68-year-old male taking olmesartan for 3-4 years. He presented to hospital with a five-week history of diarrhea, vomiting, and a 20 lb weight loss. Anti-TTG was negative with a normal IgA. Biopsies of the distal duodenum and duodenal cap revealed marked blunting of the villi with near complete villous atrophy of the biopsies from the bulb. There was an increase in intraepithelial lymphocytes as well as neutrophils in the surface epithelium. The patient's diarrhea improved upon discontinuation of olmesartan and he returned to his previous weight. Repeat endoscopy four months later demonstrated complete resolution of inflammatory change with normal villous architecture. Long-term olmesartan use is associated with severe sprue-like enteropathy. The mechanism of intestinal injury is unknown. Duodenal biopsy results may mimic other enteropathies such as celiac disease. Physicians should consider medications as potential etiologies of enteropathy.
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97
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Sáez González E, Díaz Jaime FC, del Val Antoñana A. Clinical, laboratory, serological, and histological profile of sprue-like enteropathy associated with olmesartan use. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:685-686. [DOI: 10.17235/reed.2016.4340/2016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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98
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Olmesartan-associated sprue-like enteropathy: a systematic review with emphasis on histopathology. Hum Pathol 2015; 50:127-34. [PMID: 26997446 DOI: 10.1016/j.humpath.2015.12.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/22/2015] [Accepted: 12/03/2015] [Indexed: 12/26/2022]
Abstract
Sprue-like enteropathy associated with the angiotensin II receptor blocker (ARB) olmesartan was first described in 2012, and a number of cases have since been reported. This syndrome is characterized by severe diarrhea and sprue-like histopathologic findings in the intestine, often with increased subepithelial collagen. The incidence of this adverse drug reaction is not entirely clear, although it is thought to be rare. It is also not well established if other ARBs cause such a syndrome, although case reports suggest they can. The histopathologic features of olmesartan-related injury have only been described in a limited number of cases, and there are no guidelines regarding the histopathologic distinction of olmesartan-associated enteropathy from other causes of sprue (eg, celiac disease, tropical sprue). Herein, we review the histopathologic changes and clinical observations described in recent reports of olmesartan-associated sprue-like enteropathy comprising case series and isolated reports, other relevant literature, and our experience at a referral center specializing in small intestinal disorders. We will review recent literature suggesting other ARBs can be associated with a similar phenotype. Lastly, we will discuss the histopathologic differential diagnosis and provide clues to distinguish this entity from other entities which can cause sprue-like histopathology.
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99
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Silva BMD, Neves SJ, Martínez AG, de Jesús Geneux K, García JL, Antolín SM, Millán AP. Enteropathy Associated with Olmesartan. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2015; 23:96-100. [PMID: 28868440 PMCID: PMC5580140 DOI: 10.1016/j.jpge.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/25/2015] [Indexed: 11/17/2022]
Abstract
The recognition of an enteropathy caused by olmesartan is recent. It was first described in 2012 by the Mayo Clinic, which presented 22 clinical cases. Olmesartan is a highly prescribed drug and the differential diagnosis of a sprue-like enteropathy is very wide, so it is important to be aware of this pathology. We report a case of a 67-years-old man, with arterial hypertension under treatment with olmesartan, with a 4-months history of diarrhea and weight lost. He was admitted three times in our Department during this period of time. An initial diagnosis was made of lymphocytic colitis but he did not respond to treatment with corticosteroids. There was a high suspicion of celiac disease, so the patient started a gluten-free diet but still there were no symptomatic changes. The patient underwent several blood and imaging tests which were negative. Due to the suspicion of an enteropathy caused by drugs, olmesartan was stopped and the patient showed a significant improvement of his symptoms. The exact pathophysiology of this entity remains to be elucidated. It may affect all gastrointestinal tract and mimic a refractory celiac disease as well as a lymphocytic colitis due to similar symptoms and histology. It is expected more cases like this in the future due to high use of olmesartan in current clinical practice. So, it is important to all gastroenterologists to be aware of this pathology and take it into consideration when putting together a differential diagnosis.
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Affiliation(s)
| | - Sofia Jardim Neves
- General Surgery Department, Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | | | | | - Jesús Lomas García
- Anatomical Pathology Department, Complejo Asistencial Universitario, Palencia, Spain
| | | | - Antonio Pérez Millán
- Gastroenterology Department, Complejo Asistencial Universitario, Palencia, Spain
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100
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Marietta EV, Nadeau AM, Cartee AK, Singh I, Rishi A, Choung RS, Wu TT, Rubio-Tapia A, Murray JA. Immunopathogenesis of olmesartan-associated enteropathy. Aliment Pharmacol Ther 2015; 42:1303-14. [PMID: 26423313 PMCID: PMC4626300 DOI: 10.1111/apt.13413] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 02/27/2015] [Accepted: 09/03/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Olmesartan-associated enteropathy (OAE) is characterised by diarrhoea, nausea, vomiting, abdominal pain, weight loss and severe sprue-like enteropathy, all of which are resolved after discontinuation of olmesartan medoximil. AIM To determine the mechanistic similarities of OAE with coeliac sprue. METHODS Duodenal biopsies were extracted from OAE patients before (n = 11) or after (n = 17) discontinuation of olmesartan medoxomil (on or off olmesartan medoxomil). There were seven 'on/off' paired samples. Formalin-fixed biopsies were stained for CD8, CD4, FoxP3, IL-15R and psmad 2/3. Caco2 cells (human colonic epithelial line) were treated with olmesartan medoxomil and stained for IL-15, IL-15R and ZO-1. RESULTS In the 'on olmesartan medoxomil' duodenal biopsies, a significant increase in the numbers of CD8+ cells and the number of cells that are FoxP3+ (a regulatory T-cell marker) are present in the duodenum as compared to the duodenal biopsies from patients who discontinued olmesartan medoxomil. IL15R expression is also increased with olmesartan medoxomil use. Evaluation of the effect of olmesartan medoxomil upon Caco-2 cells demonstrated that IL15 expression is increased in response to olmesartan medoxomil treatment. Further, ZO-1, a tight junction protein, is disrupted in olmesartan medoxomil-treated Caco-2 cells. CONCLUSIONS Olmesartan-associated enteropathy shares many features with coeliac disease, including symptoms and immunopathogenic pathways, such as increased numbers of CD8+ cells and corresponding overexpression of IL15 by epithelial cells. Taken together, the treatment of epithelial cells with olmesartan medoxomil induces a response by intestinal epithelial cells that is similar to the innate effects of gluten upon the epithelium of coeliac patients.
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Affiliation(s)
- Eric V. Marietta
- Department of Immunology, Mayo Clinic, Rochester, MN, USA,Department of Dermatology, Mayo Clinic, Rochester, MN, USA,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ashley M. Nadeau
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Amanda K. Cartee
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ishtpreet Singh
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Abdul Rishi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Rok Seon Choung
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Tsung-Teh Wu
- Department of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Alberto Rubio-Tapia
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Joseph A. Murray
- Department of Immunology, Mayo Clinic, Rochester, MN, USA,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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