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Melgosa Ramos FJ, García Ruiz R, Mateu Puchades A. Olmesartan Associated Enteropathy as an Inflammatory Bowel Disease Mimicker in a Patient With Hidradenitis Suppurativa. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:607-608. [PMID: 36750156 DOI: 10.1016/j.ad.2023.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/07/2023] Open
Affiliation(s)
- F J Melgosa Ramos
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain.
| | - R García Ruiz
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
| | - A Mateu Puchades
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, Spain
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2
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Gupta A, Jain P, Gupta L. Olmesartan induced gastritis and enteropathy. Indian J Gastroenterol 2024; 43:684-685. [PMID: 37466882 DOI: 10.1007/s12664-023-01382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Ankur Gupta
- Department of Gastroenterology, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, 226 010, India.
| | - Priyanka Jain
- Department of Pathology, Sahara Hospital, Viraj Khand, Gomti Nagar, Lucknow, 226 010, India
| | - Latika Gupta
- Department of Histopathology, Metropolis Healthcare Ltd, New Delhi, 110 044, India
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3
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Melgosa Ramos FJ, García Ruiz R, Mateu Puchades A. Olmesartan Associated Enteropathy as an Inflammatory Bowel Disease Mimicker in a Patient With Hidradenitis Suppurativa. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:T607-T608. [PMID: 38570088 DOI: 10.1016/j.ad.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 04/05/2024] Open
Affiliation(s)
- F J Melgosa Ramos
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, España.
| | - R García Ruiz
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, España
| | - A Mateu Puchades
- Department of Dermatology, University Hospital Doctor Peset of Valencia, Valencia, España
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Schiepatti A, Minerba P, Puricelli M, Maimaris S, Arpa G, Biagi F, Sanders DS. Systematic review: Clinical phenotypes, histopathological features and prognosis of enteropathy due to angiotensin II receptor blockers. Aliment Pharmacol Ther 2024; 59:432-444. [PMID: 38185985 DOI: 10.1111/apt.17855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/21/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Although enteropathy due to angiotensin II receptor blockers (ARBs) has been known for over 10 years, clinicians' awareness of this condition is still low. AIMS To systematically review the literature about clinical phenotypes, distribution of mucosal changes throughout the gastrointestinal tract and prognosis of enteropathy due to ARBs. METHODS According to PRISMA guidelines, we searched PubMed and Embase for relevant articles up to November 6, 2023. We included full-text papers, letters, case reports and case series describing enteropathy due to ARBs. Patients were classified into subgroups based on endoscopic and histological findings of different regions of the gastrointestinal tract. The protocol was registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/TK67C). RESULTS We included 94 articles reporting 183 cases (101 female, mean age at diagnosis 69 ± 10 years). The clinical picture at diagnosis was characterised by severe diarrhoea (97%) and weight loss (84%, median -13 kg), leading to hospital admission in 167 (95%) patients. Olmesartan (90%) was most frequently implicated. Villous atrophy (VA) was reported in 164/183 (89%) patients. One hundred and nine had only VA, 12 had pan-gastrointestinal involvement, 23 had VA and gastric involvement and 19 had VA and colon involvement (predominantly microscopic colitis). Outcomes were reported for 178/183 (97%) patients, who all recovered clinically on ARBs withdrawal. Histological recovery occurred in all 96 patients with VA at baseline who underwent follow-up duodenal biopsy. CONCLUSIONS Enteropathy due to ARBs is characterised by severe malabsorption often requiring hospital admission and can involve the entire gastrointestinal tract. Clinician awareness can lead to prompt diagnosis and excellent prognosis.
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Affiliation(s)
- Annalisa Schiepatti
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Gastroenterology Unit of Pavia Institute, Pavia, Italy
| | - Paolo Minerba
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Michele Puricelli
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Stiliano Maimaris
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Gastroenterology Unit of Pavia Institute, Pavia, Italy
| | - Giovanni Arpa
- Department of Molecular Medicine, Unit of Anatomic Pathology, University of Pavia, Pavia, Italy
- Unit of Anatomic Pathology, ICS Maugeri-IRCCS SpA SB, Pavia, Italy
| | - Federico Biagi
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Gastroenterology Unit of Pavia Institute, Pavia, Italy
| | - David S Sanders
- Academic Unit of Gastroenterology, Sheffield Teaching Hospitals, Sheffield, UK
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Fernandes L, Machado B, José Cruz A, Sarmento G, Quelhas Costa R, Pereira T, Scigliano H, Cerqueira R. Collagenous sprue: a rare cause of watery diarrhea and villous atrophy - case report. GASTROENTEROLOGY AND HEPATOLOGY FROM BED TO BENCH 2023; 16:532-538. [PMID: 37070112 PMCID: PMC10105505 DOI: 10.22037/ghfbb.v16i1.2671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 04/19/2023]
Abstract
Collagenous sprue is a rare and unrecognized cause of diarrhea and weight loss, mainly affecting the duodenum and small bowel. The clinical picture often resembles that of coeliac sprue, the main differential diagnosis, albeit, being refractory to a gluten-free diet. The histological features are fundamentally characterized by the deposition of collagen beneath the basement membrane of gut mucosa. Treatment should be initiated as soon as the diagnosis is established, so as to prevent the progression of fibrosis. We will describe the case of a 76-year-old woman with collagenous sprue, her diagnostic workup, histopathological examination, and response to treatment.
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Affiliation(s)
- Luís Fernandes
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bárbara Machado
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - António José Cruz
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Gonçalo Sarmento
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Rita Quelhas Costa
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Teresa Pereira
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Horácio Scigliano
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Rute Cerqueira
- Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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6
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Kang MJ, Min KH, Kim HW, Park SB, Kang DH, Choi CW, Kim SJ, Nam HS, Ryu DG. Olmesartan-associated Enteropathy with Acute Kidney Injury. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2022; 79:130-134. [PMID: 35342171 DOI: 10.4166/kjg.2022.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/02/2023]
Abstract
Olmesartan, a recently introduced angiotensin II receptor blocker for hypertension, has been reported to cause drug-induced small bowel enteropathy. The diagnosis of olmesartan-associated enteropathy (OAE) needs clinical suspicion and the exclusion of coeliac disease, as it mimics coeliac sprue. Once diagnosed, it can be completely cured with the discontinuation of olmesartan. However, due to the extremely low incidence of OAE in Korea, clinical suspicion and diagnosis may be a challenge. The authors report the first case of OAE presenting with chronic diarrhea and acute kidney injury in Korea.
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Affiliation(s)
- Moo Jin Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyung Hwa Min
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Bum Park
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Hwan Kang
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Cheol Woong Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Su Jin Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyeong Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dae Gon Ryu
- Department of Internal Medicine, Pusan National University School of Medicine, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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An unusual cause of diarrhoea: case report and literature review of olmesartan-associated enteropathy. Eur J Gastroenterol Hepatol 2021; 33:e1060-e1066. [PMID: 34334714 DOI: 10.1097/meg.0000000000002208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Olmesartan is an angiotensin II receptor blocker, approved in 2002 by the Food and Drug Administration for the treatment of hypertension. During chronic therapy with olmesartan, sprue-like enteropathy can occur, being mainly characterised by non-bloody diarrhoea, weight loss and variable degrees of duodenal mucosal damage, which resolved after withdrawal of olmesartan. We hereby report the case of a 77-year-old, poli-treated male patient with a 3-month history of diarrhoea, vomiting and weight loss, associated with severe intestinal villous atrophy and lymphocytic infiltration of gastric and colonic mucosa. After extensive investigations aimed at excluding other possible causes of chronic diarrhoea, a diagnosis of olmesartan-associated enteropathy was made, which was later confirmed by clinical improvement after the discontinuation of the drug. Repeated endoscopy 8 months later showed complete healing of duodenal mucosa with normal villous architecture. Villous atrophy and lymphocytic infiltration of duodenal mucosa are the most described pathologic finding, but several cases of gastric and colonic involvement have also been reported. We, therefore, reviewed the available literature, focussing on the extent of mucosal damage throughout the whole intestine and on its possible causative factors.
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Costetti M, Schiepatti A, Fraticelli S, Costa S, Maimaris S, Lenti MV, Villani L, Bianchi PI, Di Sabatino A, Corazza GR, Vanoli A, Biagi F. Clinical and gastro-duodenal histopathological features of enteropathy due to angiotensin II receptor blockers. Dig Liver Dis 2021; 53:1262-1267. [PMID: 34330666 DOI: 10.1016/j.dld.2021.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/01/2021] [Accepted: 07/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical elements differentiating enteropathy due to angiotensin II-receptor-blockers (ARBs-E) from coeliac disease (CD) are poorly defined. The histopathological features on duodenal and gastric biopsies in these patients still need to be investigated. AIMS To describe the clinical phenotype of ARBs-E in comparison to CD, and the histological findings of gastric and duodenal biopsies in ARBs-E. METHODS Clinical data of patients with ARBs-E and CD diagnosed between 2013 and 2020 were retrospectively reviewed. Baseline presenting symptoms and demographics were compared (Fisher's exact test and t-test). Gastric and duodenal histology in ARBs-E were revised by two independent pathologists. RESULTS 14 ARBs-E and 112 CD patients were enroled. Weight loss (p < 0.01), acute onset of diarrhoea (p < 0.01), hospitalization (p < 0.01), and older age at diagnosis (p < 0.01) were more common in ARBs-E. Duodenal histology in ARBs-E showed intraepithelial lymphocytosis in 71%, increased mucosal eosinophilic count in 57%, with preserved neuroendocrine, Paneth and goblet cells in all patients. Gastric histologic lesions at baseline, including lymphocytic gastritis, eosinophilic gastritis, chronic active gastritis, and metaplastic atrophic gastritis patterns were observed in 73% of patients, without Helicobacter pylori infection. CONCLUSIONS ARBs-E showed a severe clinical phenotype, often requiring hospital admission. Gastric involvement at diagnosis is very common, and this could further support this diagnosis.
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Affiliation(s)
- Martina Costetti
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Annalisa Schiepatti
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy.
| | - Sara Fraticelli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Costa
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Stiliano Maimaris
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Laura Villani
- Pathology Unit, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Italy
| | | | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Gino Roberto Corazza
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Alessandro Vanoli
- Unit of Anatomic Pathology, Department of Molecular Medicine, University of Pavia, and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federico Biagi
- Gastroenterology Unit of Pavia Institute, IRCCS Pavia, Istituti Clinici Scientifici Maugeri, University of Pavia, Via Salvatore Maugeri 10, Pavia 27100, Italy
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Sotiropoulos C, Sakka E, Diamantopoulou G, Theocharis GJ, Thomopoulos KC. Olmesartan-Induced Enteropathy: A Report of an Unusual Cause of Chronic Diarrhea. Cureus 2021; 13:e17004. [PMID: 34540405 PMCID: PMC8423377 DOI: 10.7759/cureus.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 01/09/2023] Open
Abstract
Olmesartan, an angiotensin II receptor blocker indicated in the treatment of hypertension, has been associated with a seronegative sprue-like enteropathy that should be considered in the differential diagnosis of patients with unexplained chronic diarrhoea. It typically presents with severe chronic diarrhoea, considerable weight loss, and villous atrophy on biopsy and may be difficult to recognize because of its clinical and histological similarities to other clinical entities. Practically, discontinuation of the drug leads to dramatic recovery of the symptoms. We report a 76-year-old Caucasian female who was admitted to our hospital with complaints of chronic diarrhea and significant weight loss. Medical history was notable for hypertension being treated with olmesartan. Initially, investigation for all potential infectious causes and celiac disease was negative. Both upper and lower endoscopy was performed with duodenal biopsies revealing total villous atrophy and colonic biopsies showing lymphocytic colitis. In the presence of negative serology for celiac disease and after a thorough review of the patient’s medications, olmesartan induced-enteropathy was the most possible diagnosis. Olmesartan was discontinued and the symptoms rapidly resolved. A follow-up done a few months later showed no recurrence of the symptoms. In olmesartan-associated enteropathy, discontinuation of olmesartan results in immediate clinical recovery. Although rare, it is considered an emerging and underdiagnosed enteropathy. This case report illustrates the need for a thorough medication history evaluation and regular review during workup. We aim to increase the awareness of olmesartan-induced enteropathy among clinicians and gastroenterologists. We hope it will add to the current literature and help to understand this rare phenomenon in order to avoid unnecessary testing.
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Affiliation(s)
| | - Eftichia Sakka
- Internal Medicine Department, General University Hospital of Patras, Patras, GRC
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Olmesartan-associated sprue-like enteropathy diagnosed by capsule endoscopy and double balloon endoscopy. Clin J Gastroenterol 2021; 14:1649-1654. [PMID: 34480728 DOI: 10.1007/s12328-021-01514-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
Sprue-like enteropathy associated with olmesartan is characterized by villous atrophy in the duodenum. We report the case of an 81-year-old woman diagnosed with olmesartan-associated sprue-like enteropathy with no villous atrophy in the duodenum. The patient had been taking olmesartan for 10 years and complained of diarrhea and weight loss. Despite undergoing general treatment for 2 months, her symptoms showed no improvement. Gastrointestinal endoscopy and pathological findings showed no villous atrophy in the duodenum. However, villous atrophy was observed in the small intestine by capsule endoscopy. Pathological biopsy with double balloon endoscopy provided a definitive diagnosis. Diarrhea improved with the discontinuation of olmesartan and weight increased within a week of withdrawal. After the improvement of clinical symptoms, both endoscopic and pathological findings of villous atrophy in small intestine showed improvement.
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Healthcare associated diarrhea, not Clostridioides difficile. Curr Opin Infect Dis 2021; 33:319-326. [PMID: 32657969 DOI: 10.1097/qco.0000000000000653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics. RECENT FINDINGS Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications or underlying medical conditions, sometimes Clostridioides difficile, and occasionally viruses. Other infections are rare. SUMMARY Clinical assessment remains fundamental to the evaluation of HCAD and targeted testing for C. difficile is sufficient in most patients. Multiplex gastrointestinal panels may have a role in immunocompromised patients but more study is needed. Medication-induced diarrhea is common and underappreciated and not limited to antibiotics, laxatives, and enemas.
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Olmesartan-associated enteropathy: heterogeneity of involvement along gastrointestinal tract. Porto Biomed J 2020; 5:e079. [PMID: 33195870 PMCID: PMC7657573 DOI: 10.1097/j.pbj.0000000000000079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/14/2020] [Indexed: 01/12/2023] Open
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13
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Malik A, Inayat F, Malik MI, Afzal M, Azrak MF. Olmesartan-Induced Spruelike Enteropathy: An Emerging Cause of Small Bowel Injury. Cureus 2020; 12:e9347. [PMID: 32850220 PMCID: PMC7444891 DOI: 10.7759/cureus.9347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Olmesartan-induced spruelike enteropathy is a rare clinical entity that is characterized by unexplained chronic diarrhea and weight loss. Prompt recognition of this adverse event may be challenging due to clinical and histologic similarities with other small intestinal pathologies. We hereby delineate the case of an elderly female with a 14-month clinical history of non-bloody diarrhea and weight loss. After extensive diagnostic workup and exclusion of probable etiologies, the patient was diagnosed with olmesartan-associated enteropathy. A dramatic clinical and histologic recuperation was achieved after discontinuation of olmesartan. This paper illustrates the overarching need for a detailed clinical history focusing on medication review in patients presenting with chronic diarrhea with no obvious cause. The spruelike enteropathy associated with olmesartan is an emerging cause of small bowel injury. Clinicians should maintain a high index of suspicion for this adverse drug reaction. Early and correct diagnosis carries paramount importance in sparing these patients from unnecessary diagnostic investigations and therapeutic delays.
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Makri A, Florentin M, Elisaf MS, Liamis G. Significant Weight Loss in a Patient Taking Olmesartan: An Unusual Case Report. Curr Drug Saf 2019; 14:238-241. [PMID: 30848210 PMCID: PMC6865051 DOI: 10.2174/1574886314666190307142111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/26/2019] [Accepted: 02/28/2019] [Indexed: 11/22/2022]
Abstract
Objective: Olmesartan-induced enteropathy consists a syndrome that mimics celiac disease both clinically and histologically. Cases of this entity have sporadically been reported since 2012 and are usually characterized by severe diarrhea and malabsorption, followed by significant weight loss. Case Report: Herein, we report an uncommon case of this syndrome, where weight loss preceded several months the onset of gastrointestinal symptoms. Discussion and Conclusion: Physicians should be aware of unexplained weight loss in patients taking olmesartan, as prompt discontinuation of the drug may prevent the deleterious consequences of malabsorption.
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Affiliation(s)
- Andromachi Makri
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S. Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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