Non-celiac Enteropathy and Olmesartan: An Essential Consideration

Area of Science:

• Gastroenterology
• Internal Medicine
• Pharmacology

Background:

• Non-celiac enteropathies present diagnostic challenges for clinicians.
• Olmesartan-induced enteropathy (OIE) is a rare condition that can mimic celiac disease.
• Accurate diagnosis is crucial as OIE is reversible upon medication cessation.

Observation:

• A 73-year-old female presented with chronic watery diarrhea, weight loss, dehydration, hypokalemia, and hypocalcemia.
• Extensive initial testing for infectious, autoimmune, and inflammatory causes was negative.
• Duodenal biopsies showed villous blunting and intraepithelial lymphocytosis, suggestive of celiac disease.

Findings:

• Olmesartan was discontinued due to suspicion of OIE.
• The patient experienced resolution of malabsorption and electrolyte normalization.
• Follow-up duodenal biopsies demonstrated improved duodenitis.

Implications:

• Clinicians must consider medication history, particularly olmesartan use, in patients with unexplained enteropathy.
• Early recognition and discontinuation of olmesartan can lead to significant clinical improvement.
• Increased awareness of medication-related diarrheal syndromes is essential for timely diagnosis and management.