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Severe spruelike enteropathy associated with olmesartan
Alberto Rubio-Tapia1, Margot L Herman, Jonas F Ludvigsson
1Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, USA.
Mayo Clinic Proceedings
|June 26, 2012
Summary
Discontinuing olmesartan, a hypertension drug, led to significant symptom improvement in patients with severe spruelike enteropathy. All patients experienced weight gain and histologic recovery after stopping the medication.
Area of Science:
- Gastroenterology
- Pharmacology
- Internal Medicine
Background:
- Olmesartan is a widely prescribed angiotensin II receptor antagonist for hypertension.
- Severe spruelike enteropathy is a debilitating gastrointestinal condition.
- The association between olmesartan and enteropathy was previously suspected but not well-defined.
Purpose of the Study:
- To investigate the clinical response to olmesartan discontinuation in patients with unexplained severe spruelike enteropathy.
- To evaluate the histologic changes in the small intestine after drug withdrawal.
- To establish a potential causal link between olmesartan use and this condition.
Main Methods:
- A cohort of 22 patients with unexplained chronic diarrhea and enteropathy while on olmesartan were identified.
- Celiac disease and other causes were excluded.
- Patients were included if they showed clinical improvement after olmesartan suspension.
- Intestinal biopsies were analyzed for villous atrophy, inflammation, and collagen deposition.
Main Results:
- All 22 patients experienced clinical improvement, including significant weight gain (mean 12.2 kg), after discontinuing olmesartan.
- Histologic recovery or improvement of the duodenum was confirmed in 18 patients who had follow-up biopsies.
- Biopsies revealed villous atrophy, mucosal inflammation, and collagenous sprue in a subset of patients.
- Neither tissue transglutaminase antibodies nor a gluten-free diet indicated celiac disease.
Conclusions:
- Olmesartan is strongly associated with a severe spruelike enteropathy.
- Discontinuation of olmesartan leads to expected clinical and histologic recovery.
- This finding is crucial for diagnosing and managing patients presenting with unexplained enteropathy.
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