Document Detail


Severe spruelike enteropathy associated with olmesartan.
MedLine Citation:
PMID:  22728033     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report the response to discontinuation of olmesartan, an angiotensin II receptor antagonist commonly prescribed for treatment of hypertension, in patients with unexplained severe spruelike enteropathy.
PATIENTS AND METHODS: All 22 patients included in this report were seen at Mayo Clinic in Rochester, Minnesota, between August 1, 2008, and August 1, 2011, for evaluation of unexplained chronic diarrhea and enteropathy while taking olmesartan. Celiac disease was ruled out in all cases. To be included in the study, the patients also had to have clinical improvement after suspension of olmesartan.
RESULTS: The 22 patients (13 women) had a median age of 69.5 years (range, 47-81 years). Most patients were taking 40 mg/d of olmesartan (range, 10-40 mg/d). The clinical presentation was of chronic diarrhea and weight loss (median, 18 kg; range, 2.5-57 kg), which required hospitalization in 14 patients (64%). Intestinal biopsies showed both villous atrophy and variable degrees of mucosal inflammation in 15 patients, and marked subepithelial collagen deposition (collagenous sprue) in 7. Tissue transglutaminase antibodies were not detected. A gluten-free diet was not helpful. Collagenous or lymphocytic gastritis was documented in 7 patients, and microscopic colitis was documented in 5 patients. Clinical response, with a mean weight gain of 12.2 kg, was demonstrated in all cases. Histologic recovery or improvement of the duodenum after discontinuation of olmesartan was confirmed in all 18 patients who underwent follow-up biopsies.
CONCLUSION: Olmesartan may be associated with a severe form of spruelike enteropathy. Clinical response and histologic recovery are expected after suspension of the drug.
Authors:
Alberto Rubio-Tapia; Margot L Herman; Jonas F Ludvigsson; Darlene G Kelly; Thomas F Mangan; Tsung-Teh Wu; Joseph A Murray
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2012-06-22
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  87     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-06     Completed Date:  2012-10-24     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  732-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Abdominal Pain / chemically induced
Aged
Aged, 80 and over
Anemia / diagnosis
Angiotensin II Type 1 Receptor Blockers / adverse effects*
Atrophy / chemically induced
Biopsy
Colitis, Microscopic / chemically induced
Collagen / analysis
Diarrhea / chemically induced*
Fatigue / chemically induced
Female
Gastritis / chemically induced
Hospitalization
Humans
Hypoalbuminemia / diagnosis
Imidazoles / adverse effects*
Inflammation / pathology
Intestinal Mucosa / pathology
Intestines / pathology*
Lymphocytes / pathology
Male
Middle Aged
Nausea / chemically induced
Severity of Illness Index
Stomach / pathology*
Tetrazoles / adverse effects*
Vomiting / chemically induced
Water-Electrolyte Imbalance / diagnosis
Weight Loss / drug effects
Zinc / deficiency
Grant Support
ID/Acronym/Agency:
R01 DK057892/DK/NIDDK NIH HHS; R01-DK57892/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Imidazoles; 0/Tetrazoles; 8W1IQP3U10/olmesartan; 9007-34-5/Collagen; J41CSQ7QDS/Zinc
Comments/Corrections
Comment In:
Mayo Clin Proc. 2012 Dec;87(12):1231-2; author reply 1232   [PMID:  23218090 ]
Mayo Clin Proc. 2012 Dec;87(12):1230-1; author reply 1232   [PMID:  23218089 ]

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